LEPROSY IN INDIA. 
Z3ZT JkVTHOBITT. 
SUMMARY OF REPORTS, 
FURNISHED BY THE GOVERNMENT OF BRITISH INDIA 
TO HIS HAWAIIAN MAJESTY'S GOVERNMENT, 
AS TO THE PREVALENCE OF LEPROSY IN 
INDIA; AND THE MEASURES ADOPTED 
FOR THE SOCIAL AND MEDICAL 
TREATMENT OF PERSONS 
AFFLICTED WITH THE 
DISEASE. 
HONOLULU, IL I., 1886. INTRODUCTION TO REPORTS ON LEPROSY BY THE GOV- 
ERNMENT OF BRITISH INDIA AND OTHER 
FOREIGN POWERS. 
It is about thirty years since Leprosy first attracted any serious 
attention in the Hawaiian Islands. Twenty years ago (1866) the 
dread disease had gained such a deadly hold upon the native race 
that the Hawaiian Government began to attempt to stamp out the 
scourge by segregation; for it had become a contest for the preser- 
vation or destruction of the aboriginal race. To judge by the num- 
ber of cases in proportion to the population, the disease appears to 
be more virulent and malignant in the Hawaiian Archipelago than 
elsewhere on the face of the globe. What has been attempted and 
accomplished in this twenty years' struggle with a great national 
calamity appears elsewhere. 
His Hawaiian Majesty's Government, anxious to provide every 
possible means for the treatment and understanding of the fearful 
malady, His Excellency Walter M. Gibson, His Majesty's Minister 
of Foreign Affairs and President of the Board of Health, addressed 
letters of enquiry to the Secretary of British India, to the Colonial 
Secretary of Ceylon, and to the Diplomatic and Consular represent- 
atives of the Hawaiian Kingdom in various parts of the world where 
Leprosy was known to exist, making enquiry in respect to the char- 
acter and treatment of the disease. 
The response to these enquiries has been most generous, more 
especially from governments of dependencies of Her Majesty Queen 
Victoria. In the accompanying pages will be found reports from 
every section of the vast Empire of India and its dependencies, 
from Ceylon, Hongkong, Siam, the Netherlands and their colonies, 
the Canary Islands, Norway, Spain, Mexico, Chili and Guatemala, and an extremely interesting and valuable report from the famous 
leper institution of Tracadie, New Brunswick, Canada. 
The report from the Secretary of India being so comprehensive 
and voluminous, it has been considered expedient to separate it 
from the other reports. 
In grateful recognition of the sympathy of other afflicted nations, 
this collection of reports, together with the sad history of its own 
affliction, is presented to the world by the Hawaiian Government in 
the devout hope that the Almighty, in His great mercy, may ere 
long permit suffering humanity to find the means of mitigating the 
terrible scourge. 
Honolulu, H. I., 1886. 5 
CIRCULAR LETTER. 
ADDRESSED TO HIS MAJESTY'S CONSULAR REPRESENTATIVES IN VARIOUS 
COUNTRIES IN WHICH LEPROSY PREVAILS. 
Department of Foreign Affairs, 
Honolulu, February 5th, 1885. 
Sir:-His Majesty's Government is engaged in the work of pro- 
curing, from all the best reliable sources, information as to Leprosy, 
and the social and medical treatment of lepers in other countries. 
I shall feel obliged if you will assist the Government in this matter 
by sending me such information as you may be able to obtain in 
in regard to these subjects. 
The points on which the Government is chiefly desirous of being 
informed are the following: 
To what extent does Leprosy prevail in ? 
Has Leprosy been the subject of special legislation in ? 
If so, please procure copies »f the Statutes now in force. 
Does the Government of enforce segregation of 
Lepers? If so, what steps have been taken to provide for such 
segregation ? 
Do any hospitals or asylums for Lepers exist in ? If 
so, please obtain full information as to those establishments and 
state whether they are supported by private charity or by the Gov- 
ernment. 
What is the prevalent popular opinion as to the contagiousness of 
Leprosy, and do healthy persons carefully avoid those who have the 
disease? 
I enclose a number of copies of a printed list of questions which 
will form a useful guide in prosecuting this enquiry. I shall be 
obliged by your submitting them especially to any medical men who 
may have had opportunities of studying the disease as manifested in 
I have the honor to be, Sir, 
Your most obedient servant, 
Walter M. Gibson, 
Minister of Foreign Affairs. 6 
[enclosure.] 
QUESTIONS REGARDING LEPROSY. 
The following interrogatories were prepared in 1862 for the Brit- 
ish Government by a Committee of the Royal College of Physicians 
to assist in a similar enquiry to that now being instituted by the 
Hawaiian Government. Although some of them call for informa- 
tion of a technical character, which few persons are able to furnish, 
it has been thought desirable to produce them in full. The informa- 
tion more particularly desired is as to the prevalence of the disease, 
the way in which, by law or by custom, lepers are dealt with, the 
accommodation provided for them by the State or by private charity, 
and all available facts bearing on the question whether leprosy is or 
is not contagious in each stage of development: 
1-Is leprosy known in ? If so, be pleased briefly to 
describe it as it occurs there. 
a. Are there several different forms or outward manifesta- 
tions of leprosy? If so, by what names are they respectively 
known? 
b. Are these several forms, in your opinion, only varieties of 
one common morbid state? or are they specifically distinct 
diseases, having no affinity with each other? 
c. Please enumerate succinctly the more obvious and distin- 
guishing characters of each form of leprosy which you have 
seen. 
2-At what age does the disease generally manifest itself, and 
what are usually the earliest symptoms observable? 
3-At what period of life and within what time does the disease 
usually attain its full development? and at what period of life, 
and after what time, does it usually prove fatal? 
4-Is the disease more frequent in one sex than in the other? If 
so, in what proportion? 
5-Is it more frequent among certain races? among the white, the 
colored or the black population? and in what relative propor- 
tions ? 
6-In what condition of society is the disease of most frequent 
occurrence, and what are the circumstances which seem to favor 
its development in individuals, or in groups of individuals? 7 
Please to enumerate these circumstances under the following 
heads: 
a. The character of the place or district where the disease 
most frequently occurs in respect to its being urban or rural, on 
the seacoast or inland, low, damp, and malarial, or hilly and 
dry. 
b. The sanitary condition of the dwellings, and of their im- 
mediate neighborhood. 
c. The habits of life, as to personal cleanliness or otherwise. 
d. The ordinary diet and general way of living. 
e. The occupation or employment. 
7-What conditions or circumstances of life seem to accelerate or 
aggravate the disease when it has once manifested itself in an 
individual ? 
8-Does the disease appear often to be hereditary? Have you 
known instances where one member only of a family has been 
affected while all the other members remained free from any 
trace of it? 
9-Have you reason to believe that leprosy is in any way depend- 
ent on or connected with syphilis, yaws or any other disease? 
10-Have you met with instances of the disease appearing to be con- 
tagious, in the ordinary sense of the term, i. e., communicated 
to healthy persons by direct contact with, or close proximity to, 
diseased persons? 
a. If so, in what stage was the malady in the diseased per- 
son? Were there ulcerations with a discharge? 
b. Please to describe briefly the case or cases of contagious 
communication which you have seen yourself. 
c. Does the disease seem to be transmissible by secual in- 
tercourse ? 
11-Are persons affected with leprosy permitted in to 
communicate freely with the rest of the community? or is there 
any restriction imposed, or segregation enforced, in respect of 
them ? 
12-What public provision is made for the reception and treatment 
of the leprous poor? Are they admitted into the general hospi- 
tals? or are there separate infirmaries or asylums provided for 
them ? 
Please to describe the structural and sanitary conditions of 
such buildings and the arrangements made for the medical and 
hygienic treatment of the sick in them. 8 
13-Can you state the number of leprous persons maintained at the 
public expense in ? 
14-Have you reason, from personal knowledge, to believe that the 
disease has been of late years-say during the last 15 or 20 
years-on the increase in or otherwise. And, if 
so, please to state what, in your opinion, may be contributed to 
its increase or its diminution. 
15-What results have you observed from the hygienic, the dietetic, 
or the medical treatment of the disease ? Does leprosy ever 
undergo a spontaneous cure? and if so, at what stage of the 
disease? 
Are you aware what proportion of the leprous poor treated at 
the public expense in recover wholly or partially ? 
16-What is the estimated population of ? and when 
was the last census taken? 
Is there a general and uniform registration of births and 
deaths, including the causes of death? and if so, how long has 
such a registration existed? 
17-Can you state the name of the townships or districts in which 
leprosy prevails most, and give the number of lepers and the 
population in each of such townships or districts? 9 
LEPROSY TN INDIA. 
From A. Mackenzie, Esq., c. s., 
Secretary to the Government of India, 
To The Minister of Foreign Affairs 
To His Hawaiian Majesty, 
Honolulu. 
Home Department. 
Medical. 
Simla, the October, 1885. 
Sir :-I am directed to acknowledge the receipt of your letter, 
dated the 12th March, 1885, addressed to the Secretary to the Gov- 
ernment of India in the Foreign Department, in which you desire to 
be furnished with information as to the prevalence of leprosy in In- 
dia, and especially with regard to the measures adopted for the 
social and medical treatment of persons afflicted with the disease. 
It is observed that the Hawaiian Government proposes to publish the 
results of the general enquiries which are being instituted into the 
subject as soon as they have been collated. 
2-In reply I am to forward a copy of the papers noted in the an- 
nexed schedule, giving the following particulars, in more or less 
detail, in regard to the leper asylums which at present exist in India: 
(1) The number of such asylums; 
(2) How each asylum is supported, that is, whether by public or 
private funds, or both ; 
(3) The number of lepers treated in each of the asylums during 
the years 1883 and 188-1, with the results; and 
(4) The structural and sanitary conditions of such asylums, and 
the arrangements made in them for the medical and hygienic 
treatment of the sick. 
3-With reference to the questions asked in your letter of the 12th 
March, 1885, in respect to which the Hawaiian Government is chiefly 
desirous of being furnished with information, I am directed to say 
firstly, as regards the prevalence of leprosy in India, that the dis- 
ease prevails to a greater or less extent throughout British India, but 10 
that there appears to be at least three centres of comparatively in- 
tense prevalence, viz.: 
(a) The Beerbhoom and Bancoora Districts in the Lower Pro- 
vinces of Bengal; 
(b) The Kumaun District in the Northwestern Provinces; 
(c) The Deccan and Konkan in the Bombay and Madras Presi- 
dencies, respectively. 
Details regarding the distribution of the disease throughout India 
will be found in the papers enclosed and in the tables attached to 
this letter, which have been compiled from the reports of the census 
taken in the beginning of the year 1881. These statistics cannot be 
accepted as absolutely correct, because the registration of lepers in 
general census operations is liable to error for the following amongst 
other reasons: 
(a) That Leucoderma is apt to be classed as leprosy; 
(&) That the disease is not recognized by natives until it is at an 
advanced stage; and 
(c) That affected females of the house are carefully concealed, 
the disease being in some parts of the country regarded as 
one which entails disgrace. 
The figures may however be taken to represent an approximation 
to the facts. 
4-Leprosy has never been made the subject of special legislation 
in India, and no orders have been issued by the Government of In- 
dia for the enforced segregation of lepers. 
5-As regards the number of hospitals or asylums specially de- 
signed for the reception and treatment of lepers, I am to say that there 
are in all sixteen separate Leper Asylums in India, but that it is the 
practice in many places for lepers to be treated in separate wards of 
other institutions such as general hospitals and poor houses. In the 
District of Bancoora, in the Lower Provinces of Bengal, where the 
disease is specially prevalent, the lepers in the jail are kept apart in 
a special ward. Of the sixteen asylums which exist in India, five 
are maintained partly by public funds and partly by private charity, 
nine are entirely maintained by public funds, and two are wholly 
supported by private charity. 
6-The Government of India is not in a position to say with cer- 
tainty whether leprosy is generally regarded by the natives of India 
as contagious or not. Persons afflicted with it are without doubt 
regarded in most places with aversion, but this feeling is probably 
due rather to the disfigurement and mutilations occasioned by the 11 
disease, than to any apprehension of its infectious character. In 
some parts of the country as above stated, sufferers from the disease 
are considered to be disgraced and are consequently shunned. On 
the whole, however, it is believed that the medical evidence tends to 
show that the disease is not contagious. In support of this view it 
may be mentioned that not a single servant of the asylum at Almora 
in the Kumaun District of the Northwestern Provinces appears 
to have contracted the disease during the thirty-one years for which 
there is information. Such evidence as is available tends to show 
that the disease is to a large extent hereditary, but that the influ- 
ence of heredity is much more strongly marked in the female line of 
descent. For instance, it appears that the issue of a marriage be- 
tween an affected woman and an affected man is far more likely to 
inherit the disease than the issue of a marriage between an affected 
man and an unaffected woman. 
7-I am, in conclusion, to forward the reports mentioned in the 
annexed schedule, and to express the hope of the Government of 
India that they will afford assistance in the conduct of the investiga- 
tions into the subject which are being undertaken under the orders 
of the Hawaiian Government. 
I have the honor to be, Sir, 
Your most obedient servant, 
A. Mackenzie, 
Secretary to the Government of India- 12 
INDIA. 
FROM DR. W. J. MOORE, SURGEON-GENERAL WITH THE GOVERNMENT 
OF BOMBAY. 
Extracts from Report of August Ylth^ 1885. 
Having from time to time paid considerable attention to leprosy, 
I may perhaps be pardoned adding a few remarks to this report. 
Leprosy has been known from early times. In France, in 1226, 
Louis VIL left legacies to 2,000 leper houses, and old records show 
that leper houses were once common in France, Germany, Ireland, 
and England. At present the malady corresponds as regards inten- 
sity with the belt of maximum heat of the globe; or in other words 
with those countries where great heat, comparative scarcity of fresh 
vegetables, and manner of life generally amidst unsanitary condi- 
tions, exert the most depressant effect on the human system. Al- 
though leprosy occurs in Norway, Sweden, &c., it is not now the 
same inveterate disease observed in the East. Leprosy has been 
attributed to an insufficiency of salt, but I have seen the disease 
throughout the semi-desert districts of Western India where the 
principal product of every village is salt, and even on the shores of 
the Great Sambhur Salt Lake. It has been attributed to a vegetable 
diet, but it attacks meat eaters. A too exclusive fish diet has been 
thought to be the cause, but it prevails where the people never see 
fish. It has been attributed to new rice, but people suffer from it 
who living on bAjri, only use rice as a luxury. It has been supposed 
due to malaria, but so have most other maladies, and it has never 
yet been proved that such an agent as malaria exists. It has been 
considered hereditary, and the evidence seems to show, that it like 
some other maladies may sometimes be hereditary. It has been 
regarded as contagious, and there are instances recorded which seem 
to demonstrate this view. It has been considered a form of heredi- 
tary syphilis, which we know to be both hereditary and contagious. 
Lastly, it has been attributed to unsanitary conditions generally. 13 
The features of resemblance between syphilis, especially as seen in 
former years, and leprosy are so great that they cannot be ignored ; 
and even those denying the identity of the diseases admit a form of 
leprosy which they term syphilitic leprosy. And it is an unques- 
tionable fact that the decline of leprosy in various countries has 
proceeded pari passu with the progress of sanitary measures. And 
now I come to the reason I have ventured these curt remarks, which 
might be supported by many additional arguments and facts. If 
leprosy, is as I hold it to be, (except in the minority of instances 
when originating by contagion), a latent syphilitic inherited consti- 
tutional taint, developed into activity in certain constitutions by 
surrounding unsanitary conditions, the means of preventing leprosy 
is not in reviving the antiquated system of leper asylums, but by 
measures against the spread of syphilis and by sanitation in the 
fullest sense of the term. If leprosy is not what 1 hold it to be, we 
have still sufficient evidence that the great prophylaxis is sanitation. 
In sanitation I include the prevention as much as possible of what- 
ever entails a state of human system below par, such as the cheap- 
ening of salt (an article of the greatest importance in the human 
economy), plentiful food, good clothing, suitable and above all dry 
lodging, drainage, conservancy-in short, everything tending to im- 
prove the condition of the population of a country. Leper asylums 
are good and charitable, but will not cure, eradicate or prevent 
leprosy. There is no known cure for leprosy when once contracted. 
Lepers taken into an asylum and well cared for often apparently 
recover, but the apparent recovery is this: The cathetic debilitated 
leper becomes temporarily a robust leper, but he remains a leper 
still, and the disease eventually breaks out again. Apart from 
charitable motives, therefore, I would not recommend the Govern- 
ment spending large sums on leper asylums-such, for instance, as 
would be entailed by a "State Leper Asylum," as mentioned in 
Government Resolution No. 2009, dated 11th June, 1883. A more 
certain, albeit slow progress will result from sanitation in the broad- 
est sense of the term, which comprises the moral and material 
amelioration of the condition of the people. 14 
CALCUTTA. 
FROM BABU MADHUB CHUNDER GHOSE, L. M. S., MEDICAL OFFICER, 
LEPER ASYLUM. 
Extracts from Report, 10 fitly, 1885. 
In the present state of medical science, there is no specific by 
which the disease of leprosy can be completely cured. Palliative 
treatment only can be afforded; but even under this palliative mode 
of treatment the lepers, are often very much improved in their con- 
dition,-their sores heal up, patches often disappear, and sensation 
is sometimes restored to the benumbed parts. Sometimes the im- 
provement is so marked that it is difficult for a casual observer to 
determine whether the patient had ever been afflicted with leprosy; 
but there is a great drawback to the successful treatment of cases; 
that lepers as a rule, do not seek admission to the Asylum till they 
are in a very advanced stage of the disease, when their nearest rela- 
tives shun them and axpel them from their homes, and for whom 
now the best medical treatment would avail nothing. 
BENGAL. 
FROM BABU R. M. BANERJEE, SUPERINTENDENT OF BANKOORA JAIL, 
BENGAL. 
Extract from Report, lath July, 1885. 
The medical treatment of leprosy is not a very hopeful one. Re- 
lieving as I do that leprosy when once thoroughly engraved in the 
constitution is perfectly incurable, I am not very sanguine in the 15 
efficacy of drugs in 'its cure. The best thing we can do with such 
cases is to feed them on nourishing diet; and so long as we can keep 
them in good health, they can withstand the encroachment of the 
disease; but when from any cause their health breaks down, the dis- 
ease breaks out in its terrible and horrid form, which no amount or 
excellence of medical substances can cure. Any intercurrent dis- 
eases are promptly attended to with suitable medicines. 
CIVIL HOSPITALS. 
FROM W. WALKER, ESQ., INSPECTOR-GENERAL OF CIVIL HOSPITALS, N. 
W. P. AND OL'DH. 
Extract from Report 26 June, 1885. 
No results of special treatment, as I explained in my report for 
the year 1883, are available. 
Medical men in these provinces have, after fidl investigation, 
ceased to attempt a cure of leprosy, and content themselves by en- 
deavoring to retard the ravages of the disease by attention to diet 
and cleanliness of persons. 
I quote the remarks above referred to, as they explain the posi- 
tion more fully:- 
" I may say that medical treatment in the sense of attempting a 
cure of the disease has been abandoned, not only in these provinces, 
but all over India. Extensive experiments were made in 1875, 1876 
and 1877, with regard to the efficacy of certain systems of treat- 
ment, and were found to be equally unsatisfactory. If the Govern- 
ment will refer to Proceedings in the Medical Department, Nos. 20 
and 23, dated March 10, 1877, there will be found the results of a 
fair trial given to gurjan oil, once a vaunted cure for leprosy. The 
results of this experiment may be taken as a fair example of the 
conclusions which have been forced on all trustworthy observers- 
namely, that good nourishing diet, cleanliness and friction to the 
skin with any od are the only satisfactory means of retarding the 
progress of the disease. No other specific treatment is now at- 16 
tempted in any of our asylums. The patients are regarded as in- 
curable, and are only subjected to medical treatment when attacked 
by complications which may be hopefully dealt with." 
All attempt at specific treatment has been abandoned for some 
years as useless.-[J. Fairweather, Brigade Surgeon, Inspector-Gen. 
eral of Civil Hospitals t Punjab.] 
BURDWAN 
FROM SURGEON C. II. JOUBERT, M. B. F. R. C. S., BURDWAN. 
I have ascertained that out of a population of 2,030,000 in the 
Burdwan District, inhabiting 5,181 villages or towns, 4,915 persons 
in 1,885 villages are classed as lepers. I say " classed'' because I 
am certain that many cases of secondary and tertiary syphilis are 
looked upon by the natives of this part of the country as leprosy. 
Many lepers that I have examined have attributed the outbreak of 
their symptoms to syphilis or to salivation for the cure of syphilis, 
and a great confusion of the two diseases exists in the minds of most 
natives of this district. 
We may, therefore, fairly consider that amongst these 4,915 cases 
are a considerable number of persons suffering not from leprosy but 
from syphilis, and put them against those lepers whose symptoms, if 
merely those of anaesthetic leprosy without eruption, and as yet un- 
recognized by their neighbors. 
This number gives a percentage of 0.24 of the total population. 
Roughly the greatest percentages of cases appear to exist in the 
portions of the district on or bordering on the laterite soil and 
jungle lands, while the smallest percentages are found in the tharm- 
aho in the south and east of the district comprising the alluvial lands 
lying between and near the great rivers. The disease is less com- 
mon among Mussulman than Hindus. 
The proportion of females affected was not stated in all the 
returns; but out of 3,015 lepers 564 were females, or about one to 
every live males afflicted. 17 
With regard to the propagation of the disease either by contagion 
or hereditary taint I may mention here that amongst 30 lepers whose 
cases were detailed, I only found 13 who acknowledged to any here- 
ditary history of the disease. Of the 30 ten acknowledged to hav- 
ing had syphilis and twelve denied both syphilis and hereditary 
leprosy. As regards contagion, of the 30 only one man attributed 
his disease to having lived with other lepers and denied hereditary 
taint; but as he also stated that in his village (in Beerbhoom) there 
were ten or twelve other lepers out of a population of one hundred 
or so, the denial of hereditary taint is almost worthless. 
In my opinion, I have seen nothing in the cases of leprosy that 
have come under my observation to support the popular idea that the 
disease is contagious, and the minute pathology of the disease, 
shewn by recent observers to be a disease of the nerve trunks, is 
strongly against any such theory. The purely tubercular form of 
the disease is much more rare than the anaesthetic. In my opinion, 
the disease is chiefly propagated by hereditary taint, appearing 
usually in adults. 
HOOGHLY. 
FROM DEPUTY SURGEON-GENERAL R. COCKBURN, HOOGHLY. 
Leprosy is very rare in this district. The few cases that have 
come under notice are chiefly professional beggars coming to implore 
for alms. The Hindus, in the Sanskrit works, state four forms of 
the disease. I have seen only two varieties; in short, they are the 
same only in different stages. In one, the disease commences with 
tingling sensation of a patch or patches of skin in several places, 
which become benumbed or insensible, and the coloring pigment of 
the skin is removed, the part assumes a peculiar appearance tending 
to a pink or reddish hue, the skin becomes thickened, and thus the 
affected part appears circular; ultimately the tip of the nose and the 
lobes of the ears and the skin of the eyebrows become swollen and 
reddish, and the ends of the fingers and toes, especially the big toe, 
gets painful and flattened, swollen and become of reddish hue; and 18 
in some the disease remains stationary in this stage for years, and 
even till death of the patient, or the disease advances to ulceration 
and loss of joints. The ulceration generally commences in the toes 
and fingers first, and as it advances the joints of the fingers and toes 
are separated. A sort of serum, like discharge, exudes through the 
ulcerated part, and the regular pus is not formed. When healthy 
pus is discharged from the ulcer it is generally considered that the 
ulceration stops and healing commences. The other variety is of 
the same nature in the first stage, but in the second stage dry gan- 
grene sets in on the toes, in the finger or fingers and toe or toes, and 
it proceeds as far as where the ulceration commences; and if the 
progress of the disease is to stop, then healthy pus is seen, and the 
gangrene part is separated and the ulceration heals up with healthy 
granulations. 1 have seen in several cases the toes and the rest of 
the foot fall off by dry gangrene in this way of the ankle where the 
ulceration commenced and healed up. 
The disease is generally observed to commence between the age 
of 25 and 50, but it has appeared in earlier years, but never seen by 
me to begin above the age of 50. The earliest manifestations are 
the tingling and benumbed state of the skin of some parts, or the 
swelling of the tip of the nose, lobes of the ears and its reddish hue 
with or without insensibility of the parts. 
I have seen the full development of the disease generally in adult 
age and in some cases before puberty; I have rarely seen any cases 
to prove fatal. I have seen more lepers among men than in women, 
and more among Muhammadans than among Hindus, but it is hard 
for me to give the exact proportion of it. The leprosy is more fre- 
quently seen in the lower order of the people, such as beggars; but 
the disease has been seen among the richest also, and it appears to 
spare no condition of life. 
The sanitary conditions of the dwellings of the inhabitants of this 
district are nearly all alike, and there is nothing peculiar in any 
part of the district deserving mention. The habits of life as to per- 
sonal cleanliness, I can say that the Hindus of this district are gen- 
erally most clean, daily bathing and washing their clothes and 
utensils and rooms: but the Muhammadans, excepting those who 
are in good condition, are not comparatively so clean as their 
Hindu brothers. They do not bathe, wash and clean every day. 
The diet of the people is in general vegetables, milk, fish and 
ghee. In addition to these the Mohammadans at times eat meat. 19 
Their modes of living, excepting a few young Bengalis, is very 
temperate; they touch neither wine nor stimulating liquor of*any 
sort; they are in general a race of cultivators. 
The disease is hereditary. I have invariably seen the children of 
a leper become lepers, and one thing is peculiar, that the children 
of the leper generally get the leprosy at the age of the parent when 
he first got the disease. I have seen one member of a family to be 
affected while other members remained free from it; but the man who 
had the disease generally ascribed it to his association with lepers. 
I have seen several cases of the leprosy arise as if it were the after 
consequences of syphilis. 
I have every reason to believe the disease to be contagious. I 
have seen a wife with her two children contract the disease by re- 
maining with her husband after he had the disease on him, while 
three other children who left him for the disease remained free. 
The disease of this man had not advanced to the stage of ulceration. 
I know a boy who became a leper after having bought a pigeon 
from a leper and constantly handling it, though his parents were 
free from the disease, and he had no communication with any other 
leper. I have seen two healthy, strong, good constitutional men 
having no hereditary tendency for the disease become lepers after a 
year's attendance on the lepers in a leper asylum. One was attend- 
ant to supply food from the bazaar, and the other was a water- 
bearer in the leper asylum. 
I cannot say whether sexual intercourse alone can give the disease 
or not; but when contact gives it, as a matter of course the sexual 
intercourse must communicate. 
In the district of Hooghly lepers are not allowed to mix freely 
with the rest of the communality. , The people shun a leper of their 
own accord, as they have a general belief in the contagion of it. 
There is no leper asylum in the district; in fact, it is not needed in 
the place, as there are very few lepers in the country. 20 
SERAMPORE. 
FROM DR. JAMES GREENE, SERAMPORE. 
I have no doubt leprosy is propagated by sexual intercourse, as I 
have seen several instances at the Serampore Hospital, when the 
disease was acquired in this way and mistaken at first for venereal. 
Diet has also a great deal to do with its production; most of the 
sufferers are from the homeless classes, beggars, etc., who live by 
begging, and it is well known that these people are supplied with 
grain of the cheapest and worst kind. Grain dealers, as a ride, set 
aside damaged and worm-eaten grain for distribution to this class ; 
they seldom get animal food, living principally on diseased grain 
and vegetables with a taste of rotten fish occasionally. As far as 
my observation extends, climate does not seem to have any great 
influence in the production of the disease, though there is no doubt 
that the disease is one of tropical origin. 
BANKOOR 
FROM BABU B. L. DUTT, M. D., CIVIL SURGEON OF BANKOORA. 
Leprosy is a common affection in this district. It is generally 
limited to the poorer classes, and is infrequently seen in the well fed 
and rich. The Bowrees and Southal castes suffer most, and the 
dark-skinned are more prone to the disease than the fair-skinned, 
but this may be due to the greater preponderance of the former over 
the latter. The pure Aryan, as represented by the high caste Brah- 
min, is least susceptible to the disease-a fact borne out of my 
limited observations in the Burdwan Leper Hospital and Tooree Dis- 
trict, The pure or somewhat mixed aboriginal as the Southal or the 21 
Bowree caste is, on the other hand, most susceptible as hereinbefore 
observed, and the intermediate castes appear to be more or less 
liable to the disease in proportion to the aboriginal blood in them. 
This, if proved by an extensive number of accurate observations, 
will establish an important fact. 
Anaesthetic form of the disease is the most common, tubercular 
is rarely seen, but the mixed form is more frequent. Eruption is 
observed in most cases, attended often with considerable anaesthesia 
or diminished sensation. Atrophic changes, distortion, and finally 
ulceration, and loss of substance of the hands and feet were not 
absent in a single case I observed in this district. 
Syphilis, venery, poverty and bad living are great exciting causes 
of the disease. 
The treatment adapted in the Bankoora Dispensary was liberal 
diet, cleanliness, and the continual administration of tonics. Under 
this plan two of the cases improved, and the progress of the disease 
rendered slow; but as soon as the treatment was left off, or the 
patient was reduced in health by febrile attacks or other causes, the 
disease broke out afresh with renewed vigor. 
MIDNAPUR. 
FROM R. L. MATTHEW, ESQ., CIVIL SURGEON OF MIDNAPUR. 
The native doctor in charge of the Ghatal Dispensary, in giving 
the details of a few cases that passed under his observation, states 
that the disease in three of the cases was due to hereditary influence, 
and in two was said to have been caused by contagion. 
He reports that milkmen, washermen, weavers and silkspinners 
are the classes most frequently attacked. 
Whether contagion plays an active part in disseminating the dis- 
ease appears doubtful; but the vast majority of the people here con- 
sider it contagious, and will not, as a rule, hold any communication 
with persons so affected. 22 
GHATTAL 1HSPENSARY. 
FROM BABU RAJCUMAR DOSS, NATIVE DOCTOR IN CHARGE OF GHATTAI. 
DISPENSARY. 
As to the distribution and causation of leprosy within the pre- 
cincts of this town and its immediate neighborhood, from careful 
investigation I have come to the conclusion that the disease was 
contracted in two ways, primarily and secondarily. 
In primary attacks the disease had its origin from syphilitic dis- 
orders with an injudicious administration of mercurials by native 
quacks. 
In secondary cases it has either occurred by contagion, or heredi- 
tary influence. 
Afost of the cases examined were milkmen, washermen, weavers 
and koibortos, depending on cocoon cultivation, all of whom have 
to deal with dirty things for the sustenance of their lives. 
Cases cited. A weaver boy, aged 12, hereditary influence, 
mother's maternal uncle and a nephew diseased. 
A male Hindu. His eldest brother, with whom he laid down and 
ate, was a leper; also the sister, aged 36, who contracted the disease 
at 13. 
A male Hindu, aged 25, contracted the disease from another man 
with whom he worked and slept. 
RUTHGORA. 
FROM BABU BAMA CHUM CHATTERJEE, RUTHGORA. 
True cases of leprosy with hereditary taint and special peculiari- 
ties to the locality in which the people live are wanting here. In 
the course of a year a very scanty number of patients, such as four 23 
or five, attacked with ulcers simulating leprosy, arc found to attend 
the dispensary. In most of these cases it is found on enquiry that 
they suffered from venereal disease, acute rheumatism or from any 
foul ulcer, for the cure of which they made bad use of mercurial 
preparations in the hands of quacks before the leprous ulcers broke 
out. In this quarter the abuse of mercury even in simple diseases 
tends to the development of ulcers simulating leprosy. 
GURBETTA. 
FROM BABU PROSURMO COOMAR SEIN, GURBETTA. 
• 
This disease is prevalent to a certain extent among the people of 
the village of Gurbetta. The cause is, I think, this place is com- 
paratively crowded, and as the pilgrim road passes through it, it is 
the haunt of the persons from the different parts of India who bring 
with them the contagion of many sorts of diseases. After taking 
charge of this dispensary I have treated 20 lepers. To some of 
them this disease was hereditary, to some it was owing to the conta- 
gion, and to others it was the effect of using mercurial medicines. 
CONTAI. 
FROM BABU MODIIOO MADHUB MOOKERJEE, CONTAI. 
The lepra is a disease of the skin. It has two forms, tuberculated 
and non-tuberculated; the latter is the usual case in Bengal. As 
far as my knowledge goes, this disease is neither contagious or in- 
fectious ; it is rather hereditary. If it be contagious or infectious, 
then it would have occurred among all the prisoners in the jail, as I 
have seen several cases of lepra patients in the Ilooghly and 
Hazaribagh Jails, where they live with other prisoners. Some say 
the cause of the disease is uncleanliness and dirt, but I am not of 
that opinion. The gurjun oil treatment is the best for this disease. 24 
MIDNAPUR. 
FROM SITANATH GUPTO, M1DNAPLR. 
This gentleman, a native doctor, cites the following case: The 
patient states that he was attacked with syphilis some twenty years 
before, and he freed himself from the disease with the use of mer- 
curious vapor baths. But two years after this, i. e., some twenty 
years ago, a variety of eruptions appeared on the dorsal surface of 
the right hand; this was accompanied with local amesthesia of the 
part. The eruptions healed with the use of some native oil, but the 
amesthesia still exists. Six months subsequent to this surrul ulcers 
appeared on the ends of fingers and toes, and symptoms of true 
leprosy began to appear gradually. 
MOORSHEDABAD. 
FROM DR. S. M. SHIRCORE, C. S., MOORSHEDABAD. 
Leprosy exists in an unusual degree in Moorshedabad, which 
stands fourth in the list of districts in the Provinces of Bengal, Be- 
har and Orissa, as well as of Assam. Beerbhum is at the head of 
the list. Then come Bancoorah and Burdwan, and Moorshedabad is 
next. 
Among a total population of 1,353,026, there were in the year 
1872 1,776 lepers, namely, 1,534 males and 242 females, giving a 
percentage on total population of leper males, .2377; leper females, 
.0342 ; total, . 1312. For all practical purposes these statistics are 
applicable to the present time. 
The male portion of the population of this district, like that of 
Other parts of India, suffer from leprosy greatly in excess of the 25 
female. The normal population shows a considerable excess of 
females-the figures being, males 645,335 ; females, 708,291-and 
yet the proportion of male lepers to female lepers is 6.33 to 1. 
As far as my knowledge of the lepers of this district extends, it 
appears that the disease is more common among the Muhammadans 
than the Hindus. 
Leprosy exists to a far greater extent among the people who reside 
in that portion of the district which lies on the west of the River 
Bhageeruthu. The twelve thaunahs on the east of the River Bha- 
geeruthu, with a total population of 612,203, have only 403 lepers. 
Whereas the 13 thaunahs on the west side of that river, with a total 
population of 741,423, have no less than 1,373 lepers. 
As far as I have been able to ascertain, there is nothing peculiar 
in the condition or habits of the people who reside in that part of 
the district, where leprosy is localized to such an extent, that differ* 
from those of the people of other parts. But there is a marked dif- 
ference in the natural formation of the country, the soil of the one 
being totally different from the other. 
The District of Moorshedabad is divided into two somewhat un- 
equal portions by the River Bhageeruthu, which flows through it in 
a south-easterly direction. The country on the right bank f(that is 
on the west of the river) is undulating, and generally well-raised 
above the highest flood level of the river; and the soil in its compo- 
sition is decidedly laterite, and resembles that of the plains of Up- 
per Bengal. Directly the river is crossed, the change is unmistake- 
ably marked. The surface of the country is generally below high 
flood level, and the soil is composed of sand and sand mixed with 
clay, and is, in fact, identical with that of the Gangetic delta. The 
undulations disappear, except where old beds of the river occur, 
and a flat country takes its place. 
I have stated that Beerbhum heads the list of districts in Bengal, 
Behar, Orissa and Assam in which leprosy exists to an unusual 
extent. With a total population of 695,921 there are in that dis- 
trict 2,872 lepers, giving a percentage of .4127 on total population; 
and it is deserving of remark that there are more lepers among the 
people who reside within the jurisdiction of the five thaunahs in this 
district-Bhurutpure, Khurgram, Ramporehaut, Nulhati and Pulsa, 
■which border on Beerbhum, than there are among the whole popula- 
tion of the remaining twenty thaunahs. 
As to the supposed cause of leprosy, my experience does not tend 26 
to the belief that the disease is contagious in its nature unless by 
direct inoculation, and even then we are not necessarily in possession 
of sufficient evidence of crucial test to enable us to say positively 
that the disease would be transmitted from one person to another by 
means of direct inoculation. 
On the other hand, there is no doubt that in a certain proportion 
of cases the cause of leprosy can be satisfactorily traced to heredity. 
Making, however, fidl allowance for these cases, there still remain a 
large number of cases which in the absence of any other known 
cause must be admitted to have engendered spontaneously, and for 
the origin of these cases we must look to some other causes. On the 
whole, I am inclined to the opinion that epidemic influences cannot 
be altogether absolved of a certain share in the production of 
leprosy. At all events, I think the facts I have given in this report 
sufficiently justify such an opinion, and suggest full and searching 
investigation in this direction. 
DUMKA. 
FROM THE OFFICIATING CIVIL SURGEON, S. 1'., DUMKA. 
There are .515 lepers in this district, or, in other words, .0408 per 
cent, of the population are lepers. Out of this number 314 lepers 
were returned from Dumka and Jamtarrah sub-divisions, principally 
from the villages bordering the District of Beerbhum. These are 
chiefly Bengali villages. As a rule, the Bengali villages are 
crammed with houses with defective drainage and ventilation. The 
cowdung, house refuses and other sorts of filth are piled up close to 
the house in these villages. These are the main peculiarities of 
these villages. The sufferers are chiefly poor and low class people, 
who remain overcrowded in small huts which scarcely protect from 
the rain and the inclemency of the weather. During my inspections 
of the villages from which the largest number of cases were re- 
turned, I examined fifty-nine cases in twelve villages, and found 
that in thirty cases the disease was propagated by hereditary trans* 27 
mission. In one case a woman got the disease about two years after 
her husband, from which it appears it was produced by cohabitation. 
Of the thirty-eight remaining cases, only four were attributed to 
syphilis and the use of mercury. Fish is scarce in the villages 
where leprosy is prevalent, and it cannot be traced that the use of 
putrid fish has anything to do in the causation of the disease in the 
parts of this district where it is prevalent. The poor people who 
subsist chiefly on rice, dall (kalacy, khesari, etc.,) and sag suffer 
most from the disease. 
I have only seen very few cases of leprosy among the Sonthals, 
and I believe it is not so common among them as among the Ben- 
galis; I mean the low class Hindus and Mussulmans. This may be 
probably owing to the difference of food, mode of life and better 
hygienic condition of the Sonthal villages. 
The proportion of male lepers is a little more than three times 
than the females, and the anaesthetic variety of the disease is more 
common in the district. 
Dr. Dougall's plan of treatment with gurjun oil was not so suc- 
cessful in my hands (in the few cases I tried) or in any of my sub- 
ordinates in this district. 
NUDDEA. 
FROM C. E. W. BENSLEY, ESQ., M. D., C. S., OF NUDDEA. 
From the cases which have come under my observation it seems 
to me that hereditary taint and the abuse of mercury in venereal 
diseases are the two main causes of this disease. Of these two, 
again, the latter appears to be the more common. Constant associa- 
tion might be the cause of the disease in some cases, but I am 
hardly in a position to give a definite opinion on the point. 
The cases which came to the charitable dispensary for treatment 
were all treated with gurjun oil. A marked improvement was per- 
ceptible at first in a few of the cases, but the symptoms reappeared 
soon after the patients discontinued to use the medicine. There is 
one great drawback to the examination of the result of the treatment, 
and it is that no patient is patient enough to use the medicine for 
any considerable length of time. 28 
RAJSHAHYE. 
FROM E. C. BENSLEY, ESQ., C. S., OF RAJSHAHYE. 
Doubtless the census figures (274 lepers, or a proportion of one to 
four, 783) of lepers are not strictly accurate. In the first place it is 
a disease which the people try to keep out of sight as much as possi- 
ble, those only who are actually maimed by the disease being 
brought to notice, and again, the returns for females would be de- 
fective, because of the Zenana system prohibiting any strict scrutiny. 
I do not think it has anywhere been shown that males suffer any 
more from the disease than the females, and yet the census returns 
show 229 of the former against only 45 of the latter. These, then, 
are circumstances which would tend to understate the facts; but, on 
the other hand, there is no question whatever that a large number 
of the census cases were cases of a cutaneous affection, popularly 
known as " white leprosy," which is not leprosy at all. If these, 
then, were eliminated, and an allowance made for failure in record- 
ing female cases, I imagine the figures would not vary much from 
what they now stand. 
Lepers, as a rule, represent to a great degree a floating popula- 
tion. They are much on the move, generally visiting places where 
shrines and holy places exist. In the District of Baraitch, in Oudh, 
there is a temple and a small pool of water which are visited yearly 
by a very large number of lepers. In the season these lepers, to 
the number of thirty or forty, may be seen closely packed in the 
pool with their heads above water, and about the same number or 
more around the pool ready to jump in directly vacancies occur, the 
water all the time being filthily dirty and highly offensive. The 
pool of water is said to be blessed by the Brahmins and to possess 
curative properties. 
I am unable to enter into the causes that predispose to the disease. 
I think it is allowed on all sides that poverty, filth and impoverished 
diet are not important factors of the disease, and popular notion 
exists among the natives that a fish diet produces the disease and 29 
aggravates it when it exists. The natives all believe in this disease 
being contagious, and one man was so impressed with this belief, 
as also with the loathsomeness of the disease, that he begged of me 
to keep him apart from the rest. This man was treated for a long 
time with chowlmoogra oil, and latterly with gurjun oil, and although 
there was no apparent improvement in the disease, the man had 
much improved in health, and the progress of the disease was 
arrested. 
JULPAIGURI DISTRICT. 
FROM W. DUNCAN, CIVIL SURGEON FOR JULPAIGL'RI DISTRICT. 
The district lying under the Bhootan range of hills extends from 
Assam to the Darjeeling District, a distance of about 90 miles. 
From the foot of the hills the district extends southward, with a 
varying breadth of from 40 to 60 miles. The country is generally 
level; in the northern portion, or terai, covered with dense jungle 
of wood and grass, and in the south it is one extensive rice-culti- 
vating tract. In the terai the inhabitants belong to the Meeh tribe. 
There are also a considerable number of Neapaulese, and some few 
imported Dhangurs from Sonthal. The Meehs appear, looking to 
physical conformation, an admixture of the Mongolians and the 
races of the plains. The south of the district is peopled by Ben- 
galis, Hindustanis, and a mixed breed from the two, and with the 
hill tribes. The people may be considered a rice-feeding popula- 
tion. Flesh and fish with milk, articles of food, are consumed ex- 
tensively when obtainable. Some of the terai residents are said 
to be addicted to eating flesh in a putrid form. Rice, as 
usually found for sale, is of good quality; other and inferior varie- 
ties are, however, much in use. In the district the prevailing 
diseases are malarial fevers, dysentery, diarrhoea and resulting com- 
plications. About 50 per cent, of the population suffer from 
malarial cachexia in some form. Skin diseases, tinea and itch, are 
universally prevalent, few of the people being found without one or 30 
the other, or frequently both. Elephantiasis of the extremities and 
scrotum is very common in all parts of the district. Cases of 
leprosy are to be met with in all parts of the district, and the 
disease is generally believed to be more common among the Meehs 
than among the other inhabitants. It is impossible to obtain 
accurate information as to the exact number affected among a given 
number of the population, the families in which the disease breaks 
out concealing it as long as possible ; and, when concealment is no 
longer possible, the individuals afflicted are turned out of their 
homes and allowed to gain a livelihood in the best way they can. 
All enquiries are met with evasive answers or falsehoods, because the 
fact of there being a leper in the family attaches a social taint to it. 
As bearing on the question of communicability of the disease, I 
give here notes of a case which came under my observation: A 
female, aged 28, admitted into hospital with gun shot wound of 
right thigh and comminuted fracture of femur in middle third. 
Woman well nourished and skin healthy, not related to a leprous 
family. She was accompanied by husband, aged 35, and two 
children, aged 7 and 3 years. Both children appeared healthy. 
Husband affected with leprosy, both hands ulcerating; had a 
brother with same disease. Woman recovered and aide to move 
about; only a small fistulous opening remained. This opening now 
commenced to ulcerate and the skin to crack around, and both feet 
became affected, ulcerations spreading rapidly. At this period 
both children were affected, the disease exhibiting itself in the 
hands. In all the four members of the family the disease was in 
rapid progress, when they were lost sight of. Here it would appear 
that the disease, on account of its manifestation, almost simultan- 
eously in three different subjects, must have been conveyed in dis- 
charges from sores. On the other hand, it is possible it may have 
been transmitted from husband to wife, and the children inherited it. 31 
PURNEAH. 
FROM L. PICACHY, CIVIL MEDICAL OFFICER, PURNEAH. 
Dr. Picachy gives the history of "ten reliable cases," from which 
the following extracts are taken: Eight were males; parentage 
healthy in nine cases; an hereditary taint on the paternal side trace- 
able in one; one leper says that he has two brothers-one is diseased 
and the other, as well as his parents, are healthy. Four out of ten 
are married. Wives and husbands are alive, and there is cohabita- 
tion between six. Where husbands are diseased, wives are healthy 
and vice versa. The progeny of lepers .appears not to be numerous. 
Among the cases cited, none had more than three, mostly one and 
two. The children were healthy, to all appearances, and kept so up 
to eight years, and even to adult age, but were infected with a 
diathesis, probably, capable of development later. There was no 
issue from one couple, and a healthy offspring died shortly after 
birth, whether from tainted constitution or natural cause cannot be 
determined. Intercourse is un-restrained between the married, and 
no positive separation from their different sections. Three had 
primary syphilitic ulcers only, one had secondary eruptions, and 
one man had two attacks of each anterior to the present disease, i. 
e., half the number out of ten. Salivation was undergone in one 
case. Both native and European medicines were taken in one case, 
and wild herbs in a few. Among the native remedies valued are 
strychnia, bleeding, purgatives, the flower of a vegetable called ole, 
which has tubercular protuberances like leprosy. Contagion is 
clear in the case of the Bilasee, who contracted the disease from her 
husband; and in the case of Mowlabux, who was in the habit of 
coming always in contact with his brother; and of Secom Gowla, 
whose father was a leper. The assigned causes are cultivation and 
purchase of a plot of ground belonging to a leper, cohabitation with 
a diseased husband, hereditary transmission and contagion, and will 
of Providence. It may be stated that, if malaria was among the 
causes of leprosy, this district would furnish a large amount of 
cases which it does not, and the disease is not endemic in it either. 32 
RUNG PUR. 
FROM BABU K. D. GHOSE, M. D., M. R. C. S., CIVIL SURGEON OF RUNGPUR 
The disease is distributed over the whole district and certain por- 
tions of it, in point of its prevalence, present a remarkable contrast to 
others. These tracts of extreme prevalence and comparative immu- 
nity present a marked difference in their physical features and in the 
character of the people inhabiting them, as also in the circumstances 
under which they live. During my travels of enquiry I found the 
disease more common towards the rivers than in villages far removed 
from them ; but when the immediate banks are high, it is almost 
altogether absent from them. A marked contrast of this kind 1 
observed in one part of the River Teesta. Either bank here is in- 
habited by Hindus of the fishing castes, but being of different sub- 
castes they do not intermarry or mix in other way. They follow the 
same occupation and live otherwise under similar circumstances. 
Among these fishermen on the left bank I could not find a single 
case, whereas among those on the right bank numbering about 80 
individuals there were six lepers. In the laterite tract the majority 
of the lepers that 1 found were inhabitants of the alluvial portions 
of the tract. The villages where I found the diseases most preva- 
lent are either on the banks of a river or surrounded by marshes 
and old river beds. Dry and high spots whether near a river or not 
enjoy a marked immunity from the disease. Other skin diseases 
such as itch, ringworm and psoriasis of a chronic character are very 
common in villages where lepers are found. The houses are low mat 
huts surrounded by dense jungle and clumps of bamboos. These 
latter overhanging the yards exclude the sun from them. In the 
occupation of fishing these people often immerse themselves in 
muddy water and smear themselves with mud for hours and pass 
sometimes a whole day in wet clothes. This constant contact o^ 
water with the skin, I fancy, has much influence in the production of 
the disease. It undoubtedly is a potent cause of the other skin dis- 
eases I found prevalent in these villages. In fact, the atmosphere 33 
charged with vapor; their occupation requiring constant immersion 
in water; their damp, ill-ventilated habitations, and the want of 
clothing, all tend to interfere with the healthy functions of the skin. 
The people in these villages seemed to be extremely fond of their 
homes, and never emigrate. The population of a whole village I 
sometimes found related to each other, and married and intermarried 
among themselves and lived and died in it. I found a number of 
old people who told me that they never spent a night from home. 
I examined and took notes of 378 cases, 253 males and 125 
females; 286 were Hindus 92 Mussulmans. Only in eleven cases 
could I trace evidence of hereditary taint, but I have no doubt that 
there were others among them who either concealed the truth or 
were not aware of the fact of their parents or ancestors having 
suffered from the disease. In one instance I found that two brothers 
were diseased about the same time; but they could not inform me if 
any of their ancestors suffered from it. One cannot look into the 
circumstances of the origin of the disease in several of these cases 
without believing in contagion. That personal contact alone will not 
cause the disease is evident; but it may be said to be contagious in 
the same sense as typhoid fever or cholera is contagious, though not 
to the same degree. There is strong presumption that the malady is 
due to contagium or communicable germ, which takes root and flour- 
ishes under favorable circumstances, and these favorable circum- 
stances are climate, soil and other hygienic conditions. These con- 
ditions alone cannot produce the disease ; as under similar circum- 
stances the disease does not originate. Again where the hygienic 
conditions are good, the disease, if introduced, will not spread, as it 
does not in some parts of the district, although so close to others 
infested with it. 
Numbers of cases came to my notice in which the leprous indivi- 
dual remembers having lived in close proximity to some one else 
affected, or had distant relationship with other lepers, but there were 
33 cases in which the persons lived in the same house with other 
lepers before getting it. In four of these 33 cases there was sexual 
intercourse with leprous individuals before the attack. In one vil- 
lage I found six individuals in different stages of the disease, more 
or less related to each other. A woman got leprosy first from a 
leprous husband who lived in another village. Her parents were not 
leprous. After her husband's death she came to live with her 
brother, and before she was a year in the house he got the disease. 34 
In the course of six years three other individuals in the neighbor- 
ing houses were affected. The oldest individual in this village 
assured me that before the woman returned home after her husband's 
death he had not seen a leper in that village. 
DUIAGEPUR. 
Leprosy is scattered throughout the whole district. The climate 
is bad, and there is only one mineral product in it, viz., lime, which 
lies in the form of Kunkur in scattered beds in several localities at 
various depths. The southern portion of the district is undulating; 
no mountains nor hills; a great deal of forest and barren land. The 
disease does not appear at all hereditary, most of those that 1 exam- 
ined did not get the disease till long after puberty, and they said 
that they contracted it either from the wife or husband. As far as I 
could judge, most seemed to have got it through poverty, exposure, 
bad food and worse clothing-in fact, dirty habits. There are a 
good many well-off and even in independent circumstances suffering 
from the disease. Drinking water does not seem to have anything 
whatever to do with it. Scarcely anything has been done in the way 
of carrying out general treatment. Those coming under my own 
care have had the chalmoogra oil treatment with very little benefit I 
am sorry to record. 
FROM J. W. W. WEBBER, CIVIL SURGEON OF DUIAGEPUR. 
CHUMPARUN. 
FROM THE CIVIL SURGEON, CHUMPARUN. 
Tubercular leprosy among the known cases is of very rare occur- 
rence. I have only seen three or four cases during my residence 
here. Two varieties of the non-tuberculated form are more com- 
mon, viz., the anaesthetic and the leucopathic; none are in any way 
contagious, and there is generally an hereditary history. All the 
cases I have seen or heard of are middle aged; they are of various 
castes and classes, but mostly beggars. 35 
BACKERGUNGE. 
FROM W. F. MURRAY, ESQ., CIVIL SURGEON OF BACKERGUNGE. 
Leprosy is chiefly found in the vicinity of the following villages,- 
Bagody, Sorikal, Matahar, Amanatgunge, Moolady, Burrisal and 
Rooparjur. It is not, however, confined to these places, but scat- 
tered throughout the district. Lepers live apart from their families. 
They do not take food with the other members, neither do they 
cohabit with their wives. Persons who have leucoderma are not, as 
a rule, subjected to these restrictions, but those afflicted with tuber- 
culous and ulcerating leprosy suffer most in these respects. In some 
cases the disease is undoubtedly hereditary, in other cases the causes 
cannot be ascertained. It is believed by the natives to be contagi- 
ous, but from my experience this belief is not borne out by facts. 
When taken in the early stage, the progress of the disease is greatly 
influenced by the application of gurjun ointment, which certainly is 
most beneficial, and in many cases effects a complete cure. It is 
looked on by the Native Kobirajes as a specific. 
JESSORE. 
R. T. WRIGHT, ESQ., M. D., CIVIL SURGEON, JESSORE. 
Six hundred and nineteen lepers are reported in the Jessore Dis- 
trict. The sex is not distinguished, but it appears that only 54 
inherited leprosy while 565 had no idea of its cause. They believe 
the disease incurable, so it is difficult to persuade them to submit to 
treatment, and twenty, who were treated with gurjun oil, received 
no benefit. 36 
DACCA. 
FROM A. CROMBIE, M. D., CIVIL SURGEON OF DACCA. 
Eight hundred and fifty-two lepers (723 males and 129 females), 
or 4.595 in every 10,000 of the population are affected with leprosy 
in this district. The disproportion between males and females is 
probably due to a certain extent to non-registration of female suf- 
ferers, but it is believed to be a considerable degree natural. It is 
most prevalent in the high laterite parts of the district and in the 
low water-logged thaunahs where there is little or no natural drain- 
age, where the soil dries by evaporation, and those districts return 
the smallest number of lepers which are alluvial and of medium 
elevation, with a comparatively free natural drainage. A certain 
rough relationship seems to exist between leprosy and malaria. I 
do not place any reliance on the figures supplied by the census 
returns as regards the actual number of lepers in the district. The 
people habitually confound leucoderma with leprosy on the one 
hand, and many cases of constitutional syphilis are considered as 
cases of leprosy by the laity. I am inclined to believe that there is 
more leprosy in this district than the census returns show. 
CHITTAGONG. 
FROM R. D. MURRAY, ESQ., CIVIL SURGEON OF CHITTAGONG. 
Leprosy is not common in Chittagong and it is very difficult to get 
accurate information regarding its extent. Gurjun oil, with equal 
parts of lime water, used both internally, was the treatment adopted 
in all of these cases, and gave "more or less relief." None of the 
patients attended sufficiently long to enable one to judge of the 37 
effects of the treatment; for gurjun oil is decidedly a slow acting 
medicine, and in cases where it does good or effectually cures it is 
only after many months' assiduous use. The disease does not 
appear to be specially localized. It has been most observed in the 
town, and usually among badly-off, ill-fed, up-country men, rather 
than among the aborigines, fakirs and vagrants of various sorts. 
Next to these Muhammadan ryots; then low class Hindus; and last- 
ly, Mughs, among whom the affection is very rare. No age is spe- 
cially exempt; it has been observed as early in life as 19, and as 
late as 60 years of age. Next to the station itself Rangoonea in the 
north of the district would appear to yield the largest number of 
cases; but that is probably owing to the people of that locality 
having greater facilities of communication with the town, for they 
can come down the River Kurnafoolia by one tide, and, after visit- 
ing the hospital, can return by the next. Among the cases cited is 
that of a Muhammadan Lascar, aged 36, whose disease (tubercular) 
began 12 years ago and is not traceable to any hereditary or vene- 
real taint. He states, however, that his wife and children have con- 
tracted the disease only recently, and that there are some more cases 
of leprosy in the village. 
CUTTACK. 
FROM SURGEON W. D. STEWART, CIVIL SURGEON OF CUTTACK. 
The disease does not appear to prevail in Orissa to the same extent 
that it does in the Upper Provinces. It is confined chiefly to the 
poorer classes. When it is seen among the well-to-do it is generally due 
to hereditary transmission; the evidence of transmission is generally 
very clear. In those cases where the disease originates de novo, and 
no history of heredity is obtainable, the causes are traceable to 
error of nutrition arising from unwholesome food, such as stale, or 
salted fish, diseased meat, or to living in particularly low or marshy 
localities as at Pooree and other places near the sea coast. In such 
localities there is an increase also of elephantoid disease, which is a 
periodic fever attended with gradually increasing enlargement gener- 38 
ally of the skin of leg and scrotum. Where this disease prevails, 
anaesthetic leprosy is commonly seen with more or less of the tuber- 
cular variety, etc. 
When trying the treatment of gurjun oil, I collected a few cases 
in the neighborhood of the branch dispensary for the purpose. They 
attended regularly at first, but had not patience to continue. The 
disease, however, although the benefit in all was manifest cannot be 
cured by medicine alone, patients require sufficient and suitable 
food, and many of them are unable to afford this. 
I give a brief outline of eight cases which will shew the history 
and result of treatment. In six there was hereditary transmission. 
There is a belief that syphilis occasionally develops the disease, and 
that the excessive use of mercury tends to the same effect; both 
would doubtless act in developing the disease if latent, or predis- 
posing it by causing a deteriorated state of the blood and tissues. 
A Brahmin has had anaesthetic and tubercular leprosy for past 
three years; father and mother alive, but have not the disease. On 
his mother's side, the uncle's son, his sister and her daughter, had 
the disease. Patient has a son, aged eight, no symptoms of com- 
plaint. Treatment, commenced with two drachmes of the gurjun 
oil emulsion twice a day and inunction once a day. In three months 
was much benefitted by it. 
A woman aged 30. Her father died of the disease at 40. She 
had an only child that died after its birth. One brother died years 
ago of some other complaint. There are four sisters. She is the 
eldest, the two next are at present free from the disease; the third 
one's daughter h^ the complaint; the fourth sister is also ill. As 
before, the oil continued to do good so long as it was taken, the scaly 
eruption on legs disappeared, the skin of legs became smooth, and 
swelling of face, nose and hands considerably diminished. 
A lad, aged 13, parents and brothers healthy, uncle diseased. 
A prisoner, aged 30, father and grandfather diseased. Ilis two 
wives and children and sister are free from the disease. 39 
ORISSA. 
FROM BABU JOGGO MOHUN ROY, ORISSA. 
In the generality of the cases, especially among the Hindus, vene- 
real diseases, and perhaps administration of mercury for their cure, 
have, I believe, been the cause of lepra. At least, in most of the 
instances that have come under my notice, the leprosy was clearly 
venereal. My view is further supported by the fact that the malady 
is to be met with more among people inhabiting and frequenting the 
towns than those living in the interior of the country, where the 
usual sources of the venereal diseases do not exist, at least to the 
extent they do in the towns. That the malady, as a rule, descends 
from father to children does not, I think, admit of a doubt, for I 
have seen several instances in which it has done so. I also know 
of a case in which it has done so. I also know of a case in which 
the husband has communicated the disease to the wife. 
PATNA. 
FROM BABOO RAMCHUNDER GOOPTA, PATNA. 
Syphilis is another cause of leprosy. As far as my experience is 
concerned, leprosy is not contagious. I knew a man to have been 
suffering from tubercular leprosy for a period of twenty years, and 
all this time his wife was keeping close to him, and still she was 
quite free from the disease. Moreover, of the male patients at pre- 
sent under my treatment, two are married men and have been living 
with their wives for a long time, and the wives have not been suffer- 
ing from leprosy. 40 
BARRH. 
FROM ZAHEERUDEEN, ASSISTANT-SURGEON, BARRH. 
Leprosy exists, but not to a large*extent, in the Barrh sub-divi- 
sion. The nature of the respective places in which the individuals 
laboring under this malady, and the conditions and circumstances 
under which they live, does not bear any peculiarity in its form, 
excepting that the majority of the persons are poor. Very few 
lepers are seen amongst the higher classes and well-to-do people. 
Most of the cases who attended the dispensary had previous attacks 
of syphilis. This disease was no doubt the only cause from which 
they eventually got the malady in question. In other cases the 
persons inherited the malady from their parents or forefathers. 
MONGHYR. 
FROM H. W. HILL, ESQ., M. B., CIVIL SURGEON, MONGHYR. 
Leprosy is found mostly amongst the lowest classes of society. I 
believe it is much more common among the lower orders of Mahome- 
dans than those of the Hindoos. This is due to the difference in 
habits and the nature of the food. The Hindoo, as a rule, is religi- 
ously enjoined to daily ablutions in the Ganges, where practicable, 
• or in some other clean water ; he seldom takes fish or meat; while 
the Masalman is dirty in his habits, does not carewto take a bath, 
and lives mostly upon fish and putrid flesh, such as beef or buffalo's 
flesh. 
In a few instances a hereditary transmission might be traced. I 
have met with no case in which contagion has been suspected as the 
cause. I am acquainted with several married lepers, but in none 41 
wras the disease transmitted by sexual intercourse. In many 
instances the disease has been attributed to syphilitic infection, and 
I believe this to be the most fertile cause of the disease in this dis- 
trict. There is no special locality to which it is confined, but it is 
equally distributed over the districts. 
Amesthetic variety is the most common; in fact nearly three- 
fourths of the cases belong to this class. Almost every day we 
meet with patients in the out-door dispensary complaining of patches 
of anaesthesia in several parts of the body. The color of the 
affected parts is fainter than the natural hue of the skin. This is 
known by the common name sunbahiri (i. e. anaesthesia). These 
patches rapidly increase in size, but in some instances they remain 
stationary for a long time. The tubercular variety is not so com- 
mon, but in most of these cases both varieties are combined. This 
is the worst form of the disease. 
Gurjan oil, which has been so much used of late years, does not 
hold out the prospect of bringing about a radical cure of the dis- 
ease. No doubt, by long continued use, there would be an improve- 
ment. 
The ulcers heal and the tubercular form disappears under its use. 
As soon as the oil is stopped all the symptoms reappear as before, 
no case of perfect cure being yet heard of here. 
COOCH BEHAR DIVISION. 
FROM DR. W. D. COMINS, ACTING CIVIL SURGEON, COOCH BEHAR DIVISION. 
The cause of leprosy may, I think, be hereditary or acquired, and 
syphilis and scrofula appear to be the diseases which in the parent 
most frequently lead to the development of leprosy in the child. 
Notwithstanding Dr. Carter's adverse opinion, the number of cases 
which have a syphilitic family history afford a very strong presump- 
tion that there is a connection between the two diseases. 
The people of this country feed principally on rice, vegetables, 
curries and fish, and, in the cold weather, dahee (curded milk) is 42 
occasionally used, but from necessity not from prejudice. Except 
in the case of the cow, they are not a flesh-eating people. In the 
south of the State, however, I am informed that the Mahomedans 
who live near the border eat any cattle that may happen to die from 
disease or otherwise. This is interesting, for leprosy is much more 
amongst them in that part than with their neighbors the Hindoos. 
The rice which is eaten by the lower classes is of inferior quality, 
which has been gathered only three or four months, and is therefore 
highly unwholesome and indigestible, and but little care is taken to 
remove the whole of the outer husk. How far this is a cause of 
leprosy I am unable to say. I do not think that much mouldy or 
decayed rice is eaten, though a case of gangrene of the extremities a 
few months ago was apparently due to this cause. Dall, on account 
of its price, is not eaten by the people generally, and cannot there- 
fore be looked upon as a possible cause of disease. I am not able 
to discover that leprosy is less prevalent amongst the residents on 
the larger rivers, who drink the pure snow waters of the Himalayas, 
than with those who obtain their supplies from the nearest jheel. 
It appears to be more common in the south than in the north of 
the State; more often met with on the borders than in the interior: 
more frequent amongst Mahomedans than Hindoos; amongst men 
than women and children; and amongst the poor and badly-fed than 
with the rich and well-to-do. 43 
STATISTICS IN REGARD TO LEPERS. 
The following tables are furnished by the Secretary to the Govern- 
ment of India in relation to the number of Leprous persons in Brit- 
ish India: 
TABLE I.-Showing the Number of Leprous Persons, and the 
Proportion in the Three Presidencies, together with the 
Total Population on which the Ratios have been calcu- 
lated. 
Total Popula- 
tion on which 
the Leper Ra- 
tios have been 
calculated. 
Total Lepers. 
Proportion of 
lepers in every 
10,000 (ten 
thousand) of 
the population 
Bengal Presidency 
Madras do 
Bombay do. 
156.201,210* 
31,170,631 
23,395,663 
98,017 
14,525 
12,382 
6.3 
4.7 
5.3 
Grand Total in British India 
210,767,504f 
124,924 
5.9 
* Excluding British Burma, Ajmere and Coorg. 
t Including Feudatory States. 44 
TABLE IL-Showing the Distribution of Leprosy in British 
India. 
Divisions. 
Total number of 
Loners 
Proportion of Lepers 
in every 10,000 (ten 
thousand) of the 
nonntatimi. 
Bengal and Assam. 
' Burdwan .... .... .... 
Presidency .... .... .... 
Bengal Proper ] Raj shahye .... .... .... 
Dacca .... .... 
Chittagong .... .... .... 
Total .... .... 
Behar f Patna 
wenar | Bhaugulpore ... 
Total .... .... 
Orissa .... .... .... .... 
Chota Nagpore .... .... .... .... 
Assam .... .... .... .... 
Feudatory States .... .... .... .... 
Total .... .... 
144M 
5.633 
7.170 
4.934 
1.473 
19.5 
6.9 
9.3 
5.7 
4.1 
33,636 
9.4 
8.343 
5,060 
5.5 
6.3 
13,403 
5.8 
4,661 
12.5 
2,274 
5.4 
3,314 
6.8 
2,549 
9.0 
59,837 
8.6 
North-Western Provinces. 
Meerut .... ... .... .... 
1.G92 
3.3 
Rohilkhund .... .... .... .... 
2.984 
5.8 
Agra .... .... .... .... 
843 
1.7 
Jhansi .... .... .... 
412 
4.1 
Allahabad .... .... .... 
2,199 
3.8 
Benares .... .... .... .... 
3.559 
3.6 
Kumaun with Garhwal .... .... 
1.690 
16.2 
Feudatory States .... .... .... 
433 
5.8 
Total .... .... 
13.812 
4.1 45 
TABLE II.-Showing the Distribution of Leprosy in British 
India.-Con tin ued. 
Divisions. 
Total Number of 
Lepers 
Proportion of Lepers 
in every 10,000 (ten 
thousand) of the 
population 
Oudh. 
Lucknow .... .... .... .... 
Rai Bareli .... .... .... .... 
Fyzabad .... .... .... .... 
Seetapur .... .... .... .... 
Total .... .... 
1,419 
1.107 
1,032 
885 
4,443 
5.4 
4.0 
3.2 
3.2 
3.9 
Berar. 
Berar .... .... .... .... 
3,748 
14.0 
Central Provinces. 
Nagpur .... .... .... .... 
Jubbulpore .... .... .... .... 
Narbada .... .... .... .... 
Chattisgarh .... .... .... .... 
Total .... .... 
2,489 
624 
930 
2,400 
6,443 
8.4 
2.8 
5.2 
5.2 
5.6 
Punjab. 
Delhi i .... .... .... .... 
Hissar .... • • • • • • • • • •. • 
Umballa .... • •.. • •.. • • • • 
Jullundur .... .... .... .... 
Amritsar .... .... .... .... 
Lahore • • • • .... • • • • .... 
Rawal Pindi .... • •.. .... .... 
Mooltan .... .... .... .... 
Derajat .... .... .... 
Peshawar .... .... .... .... 
Feudatory States .... .... .... 
Total .... .... 
Grand Total in Bengal Presidency .... .... 
666 
337 
819 
1,844 
1,081 
338 
1,158 
215 
153 
269 
2,854 
9,734 
98,017 
3.5 
2.6 
4.7 
7.6 
4.0 
1.5 
4.6 
1.3 
1.9 
2.3 
7.4 
4.3 
6,3 46 
TABLE IL-Showinq the Distribution of Leprosy in British 
INDIA.-Continued. 
kN 
M® 
Madras Presidency. 
s = 2 2 
? * 
• s 
tion 
ery 
sand 
datio 
: B 
® © O 
• 
Ll 
: aS? 
Districts. 
• o 
• h-h 
; m 
'Ganjam .... .... 
963 
5.5 
Vizagapatam .... .... 
856 
3.4 
Godavari .... .... 
1.037 
5.8 
Kistna .... .... 
626 
4.0 
Nellore •••• .... 
396 
3.2 
Madras City .... .... 
435 
10.7 
Sea Coast Districts 
Chingleput .... 
984 
10.0 
South Arcot .... .... 
1.208 
6.7 
Taniore .... .... 
1.072 
5.0 
Madura .... .... 
812 
3.7 
Tinnevelly .... .... 
802 
4.7 
Malabar 
1.208 
5.1 
. South Canara .... .... 
909 
9.5 
Total .... .... 
11,308 
5.3 
' Kurnool ... .... 
246 
3.5 
Cuddapah .... .... 
210 
1.9 
Bellary 
356 
2.7 
North Arcot .... 
1.161 
6.4 
Inland Districts. 
Salem .... .... 
363 
2.3 
Coimbatore .... .... 
241 
1.5 
Nilgiris .... .... 
58 
6.4 
Trichinopoly .... .... 
495 
4.1 
Puducottah Territory .... 
87 
2.9 
Total .... .... 
3,217 
3.3 
Grand Total .... .... 
14.525 
4.7 47 
TABLE II.-Showing the Distribution of Lepers in British 
INDIA.- Continued. 
Bombay Presidency. 
oon>oooaHC5NO 
Total N umber of 
Lepers ,4 ,4 .4 
Proportion of Lepers 
in every 10,000 (ten 
thousand) of the 
population 
Collectorates. 
[Khandesh .... .... .... 
| Nasik .... .... .... 
Ahmadnagar .... .... .... 
Poona .... .... .... 
Deccan.■ Satara .... .... .... 
Sholapur .... .... .... 
Belgaum .... .... .... 
Dharwar .... .... .... 
Kaladgi .... .... .... 
Total .... .... 
f Kanata .... .... .... 
1 Ratnagiri .... .... .... 
Konkan -{ Kolaba .... .... .... 
1 Bombay .... .... .... 
[ Tanna .... .... .... 
Total .... .... 
fSurat .... .... .... 
1 Broach .... .... 
Gujerat. •{ Kaita .... .... .... 
| Panch Mahals .... .... .... 
( Ahmedabad .... .... .... 
Total .... .... 
f Kurrachee .... .... .... 
| Haidarabad .... .... .... 
Sind.... j Thar and Parkat .... .... 
| Shikarpur .... .... .... 
[ Uper Sind Frontier .... .... 
Total .... .... 
Feudatory States .... .... 
L Grand Total .... .... 
6.415 
8.3 
54 
928 
432 
430 
749 
1.3 
9.3 
11.3 
5.6 
8.2 
2,593 
7.4 
383 
82 
199 
70 
76 
6.2 
2.5 
2.5 
2.7 
.9 
810 
2.8 
88 
91 
12 
69 
17 
1.8 
1.2 
.6 
.8 
1.4 
277 
1.1 
2,287 
3.3 
12,382 
5.3 48 
THE LEPER HOSPITALS OF INDIA. 
According to the report of the Secretary to the Government of 
India sixteen separate lepers' asylums exist in India, of these five 
are maintained partly by public funds and partly by private charity: 
-Umballa and Kangra, in the Punjab; Calcutta in the Lower Pro- 
vinces of Bengal and Almorah and Dehra Dun in the North-western 
Provinces. Nine are entirely maintained by public funds:-Jullun- 
dur, Amritsar, Sialkot and Rawalpindi, in the Punjub; Ratnagiri in 
the Bombay Presidency; Madras, Trichinopoly, Palliport and Agra 
in the North-western Provinces. The remaining two, Subathu in the 
Punjab and Bhandara, in the Central Provinces, are wholly supported 
by private charity. 
Lepers are also treated in many places in separate wards of other 
institutions such as general hospitals and poor-houses. In the dis- 
trict of Bancoora, in the Lower Provinces of Bengal, where the dis- 
ease is specially prevalent, the lepers in the jail are kept apart in a 
special ward. 
The structural and sanithry conditions of a fewT of these asylums, 
and the arrangements made for the medical and hygienic treatment 
of the sick in them are given, as extracted from the reports of medi- 
cal officers in charge. 
LEPER HOSPITAL, MADRAS. 
This hospital is wholly supported by Government. In 1884, four 
hundred and three patients were treated, of whom 52 died. One 
hundred and forty-five were "Relieved," with the "Remark," 
"disease incurable," and 206 remained on hand. 
The hospital consists of several blocks of buildings erected on an 
extensive piece of ground with a railed enclosure. A portion of 
this ground has separate accommodation for females. Oue large 49 
block consisting of three wards, joined to each other by a covered 
way, is for European and Eurasian male patients. Each ward con- 
tains eight beds, and has a bath-room attached; and two latrines are 
placed, at a convenient distance, for these patients. There are five 
separate wards for native patients; each accommodating 16 beds; 
and a block, divided into 6 wards, with beds for 30 patients. One 
of the former is used for the treatment of patients suffering from 
intercurrent diseases. All these patients have two separate bath- 
rooms and 4 latrines for their use. Besides the above, there are 
other buildings for the steward's office, and surgery, and there are 
three godowns, one used by the hospital contractor for stores, one 
for medicines, and the third as a lumber-room. The kitchen is 
divided into two cook-rooms ; one for Europeans and one for natives. 
There is also a dead-room separated from the rest of the hospital 
buildings. In the female enclosure there are two large buildings; 
each is divided into two wards. In the European wards there are 16 
beds, and in the native 24. Each building has a bath-room attached 
and a latrine placed at convenient distance. The hospital is sup- 
plied with water from the Red Hill Lake by taps placed in the bath- 
rooms, kitchen and gardens. A portion of the hospital compound 
is allotted to patients for cultivating country vegetables. Patients 
are visited by their friends between the hours of 10 a. m. and noon, 
and from 4 to 6 p. m. 
Treatment.-All patients, not suffering from intercurrent diseases, 
are treated by the daily application of chaulmoogra oil, mixed with 
cocoanut oil, in the proportion of 1 of chaulmoogra oil to 12 parts 
of cocoanut oil, and this is carried out as follows:- 
The European patients assemble in one of the verandahs at 7 a. 
M., and continue rubbing the oil into their bodies until 9 a. m., after 
which they take a bath. The natives begin the rubbing at 9 a. m., 
and continue it till 11 o'clock and then have their bath. All patients 
suffering from sores meet in a verandah set apart for the purpose at 
7 a. m. and 2 p.m., and have their ulcers dressed. Rice flour poul- 
tice is the chief emollient application, but special dressings are as 
carbolic oil, iodo form, camphor turpentine, sulphate of copper, 
&c., used in the form of ointment or lotion. Patients are required 
to keep their own wards, and the hospital compound clean. Some 
well-behaved men are appointed captains of wards, whose duty is to 
ensure order and cleanliness among the patients, and, when required, 
the more healthy patients are employed as orderlies, who superin- 50 
tend the cooking and look after bed-ridden patients. The night soil 
is removed from the latrines and deposited in a night-soil-cart, and 
removed by contract agreement at a cost of Rs 25 a month, whilst 
the surface drainage is accomplished by small drains leading into a 
main, which communicates with one of the town sewers. 
The establishment of the hospital is as follows:- 
1 Assistant Apothecary, 1 Steward and Writer, 1 Surgery Cooly, 
2 Peons, 2 Dhobies, 1 Tailor, 3 Cooks, 1 Dressing Cooly, 2 Male 
Ward Coolies, 2 Watermen. 1 Gardener, 2 Female Ward Coolies, 3 
Male Toties, and 2 Female Toties. A barber is engaged to shave 
the patients twice a month and is paid, according to the number that 
he shaves, from the contingencies. 
The hospital has a small library of books and periodicals contri- 
buted by the public. A small gymnasium has also been provided 
for patients who are able and like to take this exercise. 
D. R. Thompson, M. D., 
Surgeon, 1st District, in Charge Leper Hospital. 
LEPER HOSPITAL, TRICH1NOPOLY. 
The old Leper Hospital is an old District Jail, situated in the cen- 
tre of the town. There is more than sufficient accommodation for 
the number of in-door patients treated which is limited by the Muni- 
cipality to 15. The building consists of two long blocks, each com- 
posed of 8 single wards for single patients, and 2 larger wards. 1 
consider the hospital is capable of holding 40 with comfort were 
funds available. The sanitary condition is all that could be desired. 
Every part of the building being frequently white-washed and 
tarred. The conservancy arrangements are most carefully attended 
to, and the dry earth system fully carried out. Everything is 
removed daily by the Municipal carts. There is a well of "excellent 
water within the enclosure. A hospital assistant is specially set 
apart for this work, whose salary is paid in part by the Municipality 
and the remainder by the Government. The medicines required are 
supplied from the Municipal Hospital. The patients bathe daily, 
and clean clothing is provided for them. I find that the so-called 51 
unserviceable clothing from the Municipal Hospital answers admira- 
bly for this purpose. 
L. C. Canney, Surgeon Major, 
District Medical and Sanitary Officer. 
This Leper Hospital is entirely supported from public funds by 
the Municipality. The number of lepers treated here, were in 1883, 
89 ; in 1884, 127; relieved in 1883, GO; and in 1884, 87; died 8 in 
each year and leaving 1G on hand. 
PALLIPORT LAZARETTO. 
The structural and sanitary condition of the hospital is satisfac- 
tory. The buildings provided for the lepers are built of laterite, 
are filed, and having been occupied since 1728 may be said to be 
old. They are kept in good repair, an estimate being framed annu- 
ally and submitted for the sanction of the Surgeon-General before 
any work is undertaken. Of wards in the ordinary sense there are 
none, but the lepers live in rooms. 
There are three blocks, one divided into 7 rooms, the third into 8, 
and the 2nd of about double ; the dimensions of the former being a 
double block containing 15 rooms; of these one block is for females 
and two for males. The average dimensions of the rooms are 13 
feet in length, 12 feet in breadth and 10 feet in height. The total 
number of rooms used by patients is 24. The maximum number of 
patients accommodated in one room is 2, and the minimum is 1. 
Besides these rooms, the blocks contain 2 kitchens, 2 chapels, one 
fumigating and one store-room. At the entrance to the Lazaretto 
from the backwater there are two rooms facing each other, one 
serving as a surgery and the other as a store-room. There 
are separate latrines for males and females, two bathing sheds, 
three wells, a tank, and quarters for the hospital assistant. No 
provision for drainage. The Lazaretto has a dwarf wall surround- 
ing it, on which there are wooden railings, which require renewal 
from time to time. 52 
Medicines are issued daily to the patients by the resident hospital 
assistant, who is also responsible for the discipline of the establish- 
ment ; that the diets are supplied according to contract, that the 
medicines are regularly used, and that the patients take the baths, 
&c., as they are directed. Some of the inmates do a little garden- 
ing, but their existence is monotonous and but for the shelter, food 
and clothing they obtain in the asylum, their lot would be miserable. 
The Palliport Lazaretto is entirely supported by public funds 
(Government). In 1883, forty-five lepers were treated, and in 1884 
thirty-seven, three dying in the former and two in the latter year. 
The Medical Officer adds: "Disease incurable. Temporary im- 
provement whether treated by gurjun, or chauhnoogra oil, or by 
carbolic acid gas fumigation." 
There are usually thirty-four lepers under treatment, the diet of 
each costs 2^ annas a day, and they are supplied half-yearly with a 
mat and two yards of cloth each. Should any balance remain at 
the end of the financial year from the Budget allottment, two yards 
of blue cloth are given to each inmate. 
W. II. Morgan, Brigade Surgeon, 
Civil Surgeon, Cochin. 
RATNAGIRI HOSPITAL. 
Lepers only are received at this hospital which is conducted much 
the same as a dispensary. There is a committee of which the Col- 
lector is president. Civil Surgeon has the interior control under 
supervision of Medical Department. Annual allowance from Gov- 
ernment of Rs 2,000 ($1,000). From local funds Rs 2,500. The 
first only available after grant from local funds is exhausted, and 
limited to maintenance repairs by Public Works Department at Gov- 
ernment cost. 
There are three large double wards in separate blocks-verandahs 
all round-built of laterite-space for 100 beds affording 800 cubic 
feet space each. One ward occupied by females. Wall running 53 
across enclosure separates male and female wards. Four double 
cook-rooms and four latrines. Night soil removed as the site is rock 
for a long distance round, no trench possible. Bathing defective, 
one of the cook-rooms being used for bath-room. Well on premises, 
clothing and rations sufficient, hospital two miles from station, 
visited twice or thrice weekly by Civil Surgeon or when called. 
Resident Medical Subordinate. 
SASSOON INFIRM ASYLUM, POONA. 
This Asylum is for the poor and infirm of all kinds, and is con- 
ducted by a committee, the Collector of Poona being president. 
Two secretaries. The Municipality gives Rs 100 per mensem. A 
fund of Rs 51,200 invested. Donations also made towards its sup- 
port. It is situated to the west of Poona in a spacious walled com- 
pound. There are eleven separate barracks capable of accommo- 
dating eight persons each, and fairly ventilated. Also office and 
dispensary very poorly supplied with medicines; cook-rooms and 
latrines. A native medical practitioner is paid Rs 10 for visiting 
twice or thrice a w'eek. They do not profess to treat the lepers 
medically. The number of lepers in 1883-84 were 333, of whom 
277 were males. In July, 1885, there were 80 inmates, of whom 36 
were lepers. As a rule about half the number are lepers but no 
systematic records are kept. 
SIR JAMSETJI JEEJEEBHOY DARMSHALA, BOMBAY. 
This asylum is for the poor and infirm of all kinds and is con- 
ducted by a committee of the "District Benevolent Society of 
Bombay." It is supported by a grant of Rs 300 monthly interest 
on Endowment Fund of Rs 10,700. Donations (in 1884) Rs 991. 
The number of lepers in 1883 is reported as 116 and in 1884 as 138. 54 
They receive no medical treatment. There are eight long blocks of 
buildings substantially built and said to be well ventilated. Con- 
servancy cared for by Municipality on a payment of Rs 144 per 
annum. When I visited this asylum some time ago I considered the 
place cramped and crowded. No medical treatment is carried out. 
When inmates are very ill they are sent to the Bombay Hospitals. 
JAMSETJI JEEJEEBHOY HOSPITAL, BOMBAY. 
At this hospital all kinds of patients are received but lepers only 
in leper ward. It is under the management of the authorities of 
the Hospital and Medical Department.. The ward where lepers are 
received is called the uncurable ward. It is a handsome detached 
building, well ventilated, and paved with encaustic tiles and pre- 
served in the same sanitary condition as the rest of the Hospital 
ward in charge of an Assistant Surgeon under supervision of First 
Physician. Patients capable are encouraged to work in hospital 
grounds. In 1883 there were 114 lepers reported of whom 29 were 
relieved, 19 died and 44 remained. In 1884 there were the same 
number, 20 were relieved, 1G died and 38 remained. 
SAVANTVADL 
Lepers only are received in the leper ward and the hospital is con- 
ducted by the Darb&r and Political Agent. The cost is borne by 
Native State; but lepers are expected to provide their own diet 
when able to do so. Expenditure included in that of Civil Hospi- 
tal. It is situated on an elevated and well drained site half-a-mile 
from Civil Hospital. Three wards containing four beds each. 
Well ventilated. Food, clothing, water-supply, satisfactory. Out- 
houses of cook-room and latrine. Visited every day by Hospital 
Assistant, and twice a week by Civil Surgeon. In 1883 there were 
5 lepers admitted, and in 1884 there were 10, two of whom were 
relieved and 5 absented themselves. 55 
AHMEDABAD. 
This hospital is controlled by the Municipality. Lepers only are 
received in leper ward, but cholera and small-pox in adjoining 
wards. The Municipality defray the cost of establishment Rs 52 
per mensem. Provisions, clothing, contingent charges, are included 
in general accounts of Civil Hospital. It was originally a rest-house 
for travellers, situate in an open walled enclosure 140 by 152 yards; 
and 80 yards from one of the city gates. There are three blocks in 
different parts of enclosure with a well in the centre. The largest 
block is used for lepers ; the other two for cholera and small-pox. 
Pensioned Hospital Assistant in charge. Visited frequently by 
Civil Surgeon. In 1883 there were 60 lepers of whom 47 were 
relieved, one died and 12 remained. In 1884, there were 62, of 
whom 1 died, 26 were relieved and 31 remained. 
CALCUTTA LEPER ASYLUM. 
The Calcutta Leper Asylum is situated on a spot of ground in 
Amherst Street, and is divided into male and female parts (by a 
wall intervening). In the female part there are two wards, with a 
latrine, cook-house and bath-room attached. 'The male part consists 
of three wards, with a latrine, cook-house and bath-room, and also a 
small garden. The wards of the asylum are built on a raised plat- 
form, with verandahs all round, and outside the wards there is a 
pucca drain for washing away all refuse matter. The wards are 
white-washed twice during the year, and are coaled with coal-tar 
twice a year, to the height of four feet from the floor. The wards 
are washed twice a month and also disinfected, the same being done 
to the drains and latrines daily; and when a leper dies, his clothes, 
bedding, blankets, &c., are burnt. 
On the 15th October, of each year, European medicines are 56 
indented from the Calcutta Government Medical Depot, and these 
are supplemented by monthly grants from the District Charitable 
Society of Calcutta, for the purchase of oils and indigenous drugs. 
There is a medical officer attached to the asylum, who visits daily, 
and also a Resident Apothecary. There are also two dressers 
attached, with three sweepers, three cooks (Hindu, Mahomedan and 
Christian), and one durwan. 
Each leper has a good iron cot and a mattrass, and each year they 
are supplied with two dhoties and one warm blanket, and their 
clothing is always replaced when burnt. The clothing of the lepers 
is washed weekly by a phobee who is on the establishment. 
The number of lepers treated in this asylum during 1883 amount- 
ed to 178, and the number of deaths to 22; of these deaths, 1G were 
amongst new cases admitted during the year, the remainder being 
old cases. During the year 1884, there was an increase in the num- 
ber of lepers treated, viz., 200 treated. The number of deaths 
amounted to 2G ; of these deaths, no fewer than 20 were amongst 
new admissions, and only G amongst the old cases. This is rather 
satisfactory, as during the year, owing to overcrowding in the wards, 
there was an epidemic of erysipelas, which, I am glad to say, was 
soon checked by taking proper sanitary measures, as well as by the 
segregation of the lepers, but unfortunately six of the lepers fell 
victims to the disease. 
At present the wards of the asylum are overcrowded, many lepers 
being refused admission for want of accommodation. Each leper 
on an average has a very diminished supply of cubic feet of air to 
breathe, instead of 1,500 cubic feet as allowed on the best hygienic 
principles. For instance, in the Hindu ward, which is by length 70 
feet, breadth 18 feet, height 14 feet, and containing at present 28 
inmates, it will be seenvthat only G30 feet of air is the allowance for 
each inmate, which is less than half the quantity which ought to be 
allowed. This is a very serious drawback and entails consequences 
which may be very deplorable in an outbreak of epidemic disease. 
The former diet of the lepers at this asylum was poor and meagre. 
In June, 1884, new scales of diet were sanctioned, which are now on 
an equal footing to the diet of different native hospitals of Calcutta. 
The new diet has greatly improved the condition of the lepers. 
They have gained in flesh; they do not suffer so much now from 
foul sores; and it has reduced the mortality to a certain extent, as 
since its introduction up to the close of the year one only died from 57 
the old patients, and six from the new cases, who were bought into 
the asylum in a moribund condition. 
With the exception of a subscription of Rs 100 a month from the 
corporation of Calcutta, and an annual grant of European medicines 
from the Government Medical Store, the institution has been sup- 
ported entirely by the District Charitable Society, and was a heavy 
charge on its " General Fund." But about two years ago, two 
legacies and a donation from Mr. Greece Dutt were made over to 
the Society for the purpose of forming a " Leper Asylum Fund," 
and this capital, amounting to Rs 34,900, is now invested in Govern- 
ment securities. The average monthly cost of the asylum is Rs GOO, 
exclusive of municipal taxes and repairs. 
BANKOORA JAIL, BENGAL. 
The leper ward is a building consisting of three rooms, situated in 
a spacious and airy yard and separated from the rest of the jail. 
Conservancy is carried on upon the system of receiving excreta in 
pulverized dry earth, covering them with it, and removing them to a 
distance for burial. Water is supplied from wells in the jail, which 
require deepening, and is filtered. Clothing and food are supplied 
as to other prisoners, with such variations as the medical officer may 
think necessary. The present superintendent of the jail is a native 
Assistant Surgeon, who has a Civil Hospital Assistant under his 
orders. They treat the lepers as they would any other sick in the 
jail. I consider the jail at Bankoora the most healthy in the pro- 
vince. 
The superintendent supplements the above report of Officiating 
Inspector-General of jails, E. V. Westmacott, Esq., by stating that 
the leper ward consists of two rooms with an ante-room. Of the 
two wards, one is larger than the other, the former measuring G48 
cubic feet and accommodating 20 prisoners, the smaller measuring 
500 cubic feet and accommodating 18. The ante-room is a small 
one, occasionally used for the isolation of bad lepers, where they 
are treated separately from the rest. The number of lepers treated 
in 1883 was 30, with one death, and in 1884 was 36, with only one 58 
death. Of the rest, some are still in jail; the others were dis- 
charged on expiry of their sentence. They are all criminals. 
Every possible attention is paid to the hygienic condition of the 
lepers confined in this jail. The wards are large and rooms well 
ventilated, with opposite doors and windows, admitting air and light 
in more than sufficient quantity ; situated in the midst of a large 
compound having perfect southern exposure, and separated from the 
main ward of the jail. The state of the conservancy and removal 
of the night soil is all that could Be desired, and is done according 
to jail regulations. For purposes of cleanliness, bathing and wash- 
ing they get sufficient water from a well situated in their compound, 
and get enough of wholesome filtered water for drinking purposes. 
They get their food according to scale No. 1 for laboring prisoners, 
with such varieties and extras best suited for their condition. They 
pass their days in the open air, being engaged in some light labor, 
chiefly hewing of grass and husking nim seeds, &c. They are well- 
clothed. By these comforts and attentions their condition after 
admission becomes considerably improved, and they go out in a 
better state of health than they came in. Outside the jail nothing 
can be more miserable than the state in which they live. Suffering 
from privations of all sorts, without any proper shelter to protect 
them from the inclemencies of the weather, without proper clothing, 
living as they generally do on begging, they scarcely get a full meal 
in their life; they readily succumb to the ravages of the disease. 
ALMORA LEPER ASYLUM. 
Ill the North-western Provinces there are only three Leper Asy- 
lums-that is to say, institutions devoted solely and entirely to the 
maintenance of lepers: these are the Almora, Dehra Dun, and Agra 
Leper Asylums.- But besides these institutions, lepers are received 
into 22 poor-houses, situated at the headquarters of' as many dis- 
tricts, along with blind and destitute poor. 
The Leper Asylum at Almora is supported partly by the interest 
which accrues from a funded capital of Rs 30,000 and partly from 
private subscriptions. The chief portion of the capital fund was, 59 
I believe, made over to the trustees of the asylum by the Government 
of the North-western Provinces many years ago, in the shape of a 
balance of a stock of tea left in the hands of Government, when it 
withdrew from the tea industry in Kumaun. During the past year 
(Report dated June, 1885), the income of the Almora Asylum was 
Rs G,388, the principal sources being private subscriptions Rs 3,085, 
and interest on capital Rs 2,145. It may thus be said that of the 
income, exclusive of Rs 949 cash balance, the Government contri- 
buted 41 per cent., the Municipality 2 per cent., and private sub- 
scribers 57 per cent. 
At Almora the lepers are housed in ranges of cottages built on a 
gently sloping hill side, the females being separated from the males 
by a low divisional wall. There is a small dispensary in charge of a 
locally-entertained Native Doctor-a store-room and grain go-down, 
and a small chapel, the institution being under the immediate super- 
vision of the resident missionary of the London Independents. The 
whole of the asylum is surrounded by a low wall, and the grounds 
are planted with trees. In 1883, 137 were " benefitted " leaving 
127 on hand, and in 1884, 130 were benefitted, leaving 107 on hand. 
THE DEHRA DUN LEPER ASYLUM. 
This asylum was until last year supported entirely by private con- 
tributions. The late Mr. Wilson, of Mussooree, contributed a sum of 
Rs 20,000 to form the nucleus of a trust fund, and this has been 
added to until it now amounts to close on Rs 25,000. Since last 
year, the Government of the North-western Provinces and Oudh has 
made an annual grant of Rs 1,500 towards the support of the asy- 
lum ; so that, taking the income of the past year as an index to its 
resources, the Dehra Dun Leper Asylum receives from private sub- 
scriptions, 27 per cent. ; from interest on securities, 27 per cent.; 
from the Municipalities of Mussooree and Dehra, 17 per cent, and 
from the Government, 29 per cent. 
The asylum is divided into a male and female side, each consist- 
ing of an enclosure surrounded by a wall, and having lean-to sheds 
erected against the walls as dwellings for the lepers. 60 
The Hospital Assistant, attached to the jail and police, proscribes 
for the sick of the asylum, and for the purpose visits it daily, the 
whole being under the supervision of the Civil Surgeon. In 1883, 
the number of lepers benefitted was 92, leaving 51 on hand, and in 
1884, 71 were benefitted, and 53 left on hand. 
THE AGRA LEPER ASYLUM. 
This asylum is supported entirely by the Municipality, and is situ- 
ated in an old garden enclosure on the banks of the Jumna, the 
house for the lepers being lean-to erections against the outer 
enclosure walls. The Hospital Assistant of the Chhatta charitable 
dispensary visits and prescribes for the sick. In 1883, twenty-three 
lepers were benefitted, leaving a like number on hand, and 1884, 
thirty-three were benefitted, leaving 24 on hand on December 31st. 
POOR-HOUSES AND ASYLUMS. 
In the Poor-houses, which receive lepers as well as blind and help- 
less poor, the lepers are supported by the funds raised for the gen- 
ral purposes of the charity. Of the Poor-houses in which lepers are also 
received, it may be said that they all have the services of the Hospi- 
tal Assistants whose sphere of work is nearest to them, and there is 
generally a clerk or daroga in charge of the accounts. I must 
repeat, however, that no special medical or hygienic treatment is 
now attempted for the cure of lepers, although they receive when 
sick, the same attention as the other inmates of the Poor-houses. 
These Poor-houses are located at Allahabad, Bareilly, Benares, 
Bahraich, Bara Banki, Biinda, Cawnpore, Farukhabad, Fyzabad, 
Gh&zipur, Gonda, Hardroi, Kheri, Lucknow, Meerut, Moradabad, 
Muttra, Orai (Jalaun), Rae Bareli, SahAranpur, ShdhjahAnpur, Sita- 
pur and Sultdnpur. At these places there were benefitted in 1883, 
465 men, 200 women and 35 children, leaving 148 men, 47 women 
and 4 children on hand. In 1884, there were benefited 457 men, 
151 women and 42 children, leaving 151 men, 55 women and 7 chil- 
dren on hand on December 31st. 61 
UMBALLA ASYLUM. 
There are seven Leper Asylums in the Punjab Province, namely, 
Umballa, Kangra, Jullundur, Amritsar, Sialkot, Rawalpindi and 
Simla. 
This asylum is near the Umballa City. It is an American Mission 
Institution, and is under the sole control of the missionaries. It is 
supported partly by Municipal and District Funds, and partly by 
private subscriptions. Of the total income of Rs 2,052 for 1884, 
including a balance of Rs 351 from the previous year, Municipal 
and District Funds contributed Rs 1,100 or more than a half. 
The asylum consists of a block of 5 buildings, viz., 3 low-built 
Kutcha barracks, a "Prayer-room," and a building containing a 
room for the compounder and chaukidar. The barracks are about 
70 feet long by 16 broad, divided into 23 rooms of about 12 feet by 
10 each, with a 6 feet wide verandah. The "Prayer-room" is 30 
feet by 18, and here the lepers assemble for religious instructions by 
the missionaries. Dr. Bateson, Civil Surgeon, thinks there is a 
great want of ventilation in the barracks. There is no latrine; but 
as the asylum is in an unfrequented place near sand-hills, the Civil 
Surgeon thinks one hardly necessary. The Civil Surgeon visits the 
asylum once a week, or oftener if necessary. No specific treatment 
is now adopted. Such medicines as are required are supplied gratis 
from the City Dispensary. The number of lepers treated during 
the years 1883 and 1884, were as follows: 1883, 40; 1884, 48; of 
these, 2 died in 1883, and 12 in 1884, leaving 35 remaining. ' 
THE KANGRA ASYLUM. 
This asylum is situated in a beautiful spot in the centre of a tea 
garden, about a mile from the Dharmsala Jail, and at an elevation 
of over 4,000 feet above the sea. It is supported by District and 62 
Provincial Funds, and by the interest of Rs 5,800 which have been 
gradually invested in Government 4 per cent, promissory notes. 
The foundation of this Endowment Fund was a sum of Rs 1,500, 
which was given by Colonel Lake, formerly Commissioner of the 
Division, and it has gradually been increased by donations and sub- 
scriptions, chiefly from the visitors of Dharmsala and the residents 
of the Kangra Valley, both European and native, which have been 
collected by successive District Officers of Kangra. The expendi- 
ture last year was Rs 857. During 1884, 21 lepers were treated, 
2 dying, 1 leaving and 18 remaining. 
The asylum buildings consist of two parallel rows of barracks, 
built of stone and roofed with rough slates. They face each other 
and are separated by a bit of garden ground. One room of bar- 
racks is occupied by males and the other by females. The huts are 
kept fairly clean, but there is a want of ventilation in them. Their 
situation, however, on a pine covered ridge, at an altitude of 4,000 
feet or more above the sea, renders free ventilation not so necessary 
or desirable as in the plains. On the whole, the lepers here seem as 
comfortably situated as their miserable condition will admit of. A 
spring in the neighborhood supplies them with plenty of good drink- 
ing-water. 
A hakmi, who also knows European medicine, is employed to 
superintend the asylum and to minister to the lepers' ailments; but 
no special method of treatment has been tried for some years. The 
Civil Surgeon of Dharmsala visits the asylum at times. 
THE JULLUNDUR ASYLUM 
Is at a place called Dakni Sarai, about 5 miles from the town of 
Nakodar. It is supported by "malba" or village funds, collected 
with the land revenue. The cost of maintenance of the lepers 
belonging to other districts is recovered from the districts con- 
cerned, the cost of maintenance of each leper being calculated at 
Rs 5 per mensem. The number treated in 1883 was G9, of whom 4 
died, 20 left and 45 remained at the end of the year. In 1884, 89 
were treated, 6 dying, 21 leaving of their own accord and 62 63 
remaining at the end of the year. The mortality for the two years 
has been 6.32 per cent, of the total treated. The building in which 
the lepers are accommodated is an old Badshahi Sarai, which is large 
enough to hold 200 if required. It is on the banks of the Eastern 
Beyn, and is favorably situated for drainage. A compounder on 
Rs 12 a month is employed to look after the lepers, and under him 
there are a chaprassi, a bhisti, and two sweepers. The place is 
kept clean, and the dry earth system is carried out. No special 
treatment is adopted. The Civil Surgeon frequently inspects the 
asylum. 
THE AMRITSAR ASYLUM 
Which is the largest and best provided in the Province, is situated 
about a mile from the town of Tarn Taran, 12 miles south of Amrit- 
ras. It is supported by Amritsar Municipal Funds, which pay all 
expenses; and at the close of the year, the amount is recovered 
from the districts to which the lepers belong. In 1883, 349 lepers 
were treated here, 23 died, 100 left of their own accord and 226 
remained over; in 1884, 305 were treated, 33 died, 40 left of their 
own accord and 232 remained at the end of the year. The mortality 
was 8.5G per cent, of the total treated. 
The leper settlement or colony at Tarn Taran consists of three 
lines of huts running parallel, but without plan or order, of all sizes 
and shapes, with kutcha walls and roofs. There is no enclosing 
wall, so that the lepers are at liberty to roam about as they please, 
and to picket their cattle in the open near their houses. There are 
about 140 huts, some having small enclosures During the past 15 
years, much has been done to increase the accommodation, baths 
have been appended to the wells, latrine accommodation has been 
built, and a house for the Hospital Assistant and a large garden 
have been provided. So far as isolation of the leper goes, there is no 
provision whatever, because he is constantly absconding or obtaining 
leave. Nor can the present arrangement be considered in any 
sense as a hospital. It is impossible for the Civil Surgeon to super- 
vise it. There have been spasmodic attempts made at different 64 
times in regard to the treatment of the disease, viz., the use of gar- 
jan oil, and sweet oil and nerve stretching. The sexes mingle, and 
the rising generation of lepers may be seen running about in the 
colony. The huts are, as a ride, filthily dirty and untidy, and the 
general aspect of Tarn Taran Leper Asylum depressing to a degree. 
The sick and urgent cases are provided with medical treatment, 
there being both a Hospital Assistant and a dresser resident, with a 
well-stocked dispensary ready for emergencies. Rs 3 per month are 
given to each adult, and Rs 1-8 to each child, from the Munici- 
pality of Amritsar. A liberal supply of blankets is furnished in the 
cold weather, and there is a staff of bhisties and mehters. The 
Rev. Mr. Guildford, who lives at Tarn Taran, now takes consider- 
able interest in the lepers. 
THE SIALKOT ASYLUM 
Is situated at a place called Baba Lakhan, about 8 miles from the 
town of Sialkot. It is maintained entirely from District Funds. In 
1883, 49 lepers were treated, of whom 2 died, 6 left of their own 
accord and 41 remained; in 1884, 46 were treated, 7 died, 2 left of 
their own accord and 37 remained at the end of the year. The 
mortality for the past two years has been 9.47 per cent, of the total 
treated. The asylum building consists of three double barracks of 
pucca brick, with accommodation for 72 lepers. It is well situated, 
and the sanitary conditions are satisfactory. There are two good 
wells and a garden attached to it. The establishment consists of a 
compounder, cook, kahar and sweeper. 
THE RAWALPINDI ASYLUM 
Is situated in a pleasantly wooded place, about half-a-mile to the 
north-east of the city. It is supported by District and Municipal 
Funds. The total amount expended during the year 1884, was Rs 
1,904-6-11, of which District Funds contributed Rs 686-3-5 and 
Municipal Funds, Rs 1,218-3-6. In 1883, 49 lepers were treated, 65 
2 died, 6 left and 36 remained at the end of the year; in 1884, 45 
were treated, 2 died and 39 remained at the end of the year. 
The buildings consist of eight separate barracks, one of which 
contains 8 rooms, five contain four rooms each, and two (which are 
in a ruinous state) have 2 rooms each. The large barrack contain- 
ing 8 rooms is in good repairs, having been built only a year ago. It 
has two roomy verandahs, one on each side, and the apartments are 
comfortable and fairly ventilated. One of the barracks containing 
four rooms being occupied by the servants of the asylum, there 
remains accommodation for only 24 patients, while the number now 
in the asylum is 49. 
Rs 1,200 has been budgetted for to build a new block capable of 
holding 8 lepers; but as yet no arrangements have been made to 
carry out the work. The latrine arrangements are now reported to 
be good, there being a separate latrine for males and females, each 
supplied with iron utensils and the dry earth systems adopted. The 
drinking-water is got from a pucca masonry well, and is much 
esteemed by the people of the town, who largely resort to it for 
their domestic supply. The Assistant Surgeon in charge of the 
Civil Dispensary affords medical aid when required, but there is no 
attempt at any special treatment, An establishment is kept up con- 
sisting of a dresser, a cook, a kahar, a chaprassi, a bhisti, and a 
sweeper. 
THE SABATHU ASYLUM 
Is another institution which is entirely under the management of the 
American Presbyterian Missionaries. It is supported by private 
funds collected in India, Great Britain and the United States of 
America. The total income for the past two years has been Rs 6,752 
and Rs 6,842, and the expenditures'Rs 2,284 and Rs 2,834. 
The lepers receive a monthly allowance in cash of Rs 3 to Rs 3-8 
each, from which they supply themselves with food, clothing and 
fuel; but warm clothing and blankets are given to them extra during 
the winter. From the fact, as shown by the accounts, that consider- 
able sums are found on the lepers after death, it would appear that 66 
the allowance given is ample fortheir wants. In 1883, 112 were 
treated, of whom 13 died, and in 1884, 104, of whom 10 died. The 
asylum is situated not far from the American Mission House at Saba- 
tini on a breezy, sunny ridge. The houses consist of a series of 
barracks arranged in a row along the ridge and divided into com- 
partments large enough to lodge two lepers in each. They are said 
to be well ventilated, and have a verandah in front. The sexes are 
strictly kept apart in different barracks, and they have patches of 
garden ground which they cultivate themselves when able to do 
so. Latrines are erected at convenient distances, and are attended 
to by a sweeper. Bhisties are employed to bring water to the lepers. 
Dr. Newton, American Missionary, who was for many years in 
charge of the asylum, and who took the keenest interest in lepers, 
died in 1880, and the Rev. A. Rudolph is now in charge, assisted by 
a native Christian compounder, who attends to the ailments of the 
lepers. All attempt at specific treatment has been abandoned for 
some years as useless. During 1883-4, 1,346 lepers have been 
treated in the asylums of this Province (Punjab) of whom 118 have 
died, giving a mortality for the two years of 8.76 per' cent. The 
highest mortality has occurred in the Umballa Asylum, 18.9 per 
cent., and the lowest 4.25 per cent, in the Rawalpindi Asylum. 
TREATMENT OF LEPROSY IN INDIA. 
EXTRACTS FROM REPORT ON CASES OF LEPROSY TREATED BY SURGEON 
C. T. PETERS, AT BELGAUM, DATED BOMBAY, JUNE, 1879. 
The people were very sceptieal as to their ever being cured, or 
even relieved, of such a dreadful malady as leprosy, for which they 
have been cast out by friends And society, and made dependent on 
charity for their daily bread. One of them, however, a Goanese, 
in whom the disease had only existed for a couple of years, was 
selected for treatment. He was made to attend at the Civil Hospi- 
tal daily, where he had a bath at about 9 a. m., with soap and warm 
water, which was followed by an inunction of carbolic oil (in 20 67 
parts), and the open sores dressed with a somewhat stronger car- 
bolic oil (in 10 parts). Internally, he was treated with chalmogra 
oil (five minim doses), and occasionally iodide of potassium. After 
having assiduously taken these remedies for about six months, he 
fully recovered the sensibility in the extremities, the sores healed, 
and in every other respect he felt so well that he left the asylum to 
join his relatives in Goa with a feeling of deep gratitude. (An 
appended note states: "Six years later (in 1877) this man returned 
to the asylum with aggravated symptoms of leprosy, said to have 
recurred since the famine set in.") The others in the asylum had 
not so much confidence, and it was very difficult to get them to 
attend regularly. 
On my being transferred to Poona in 1873, I undertook the charge 
of a leper, whom I commenced to treat in the same way. He was 
improving slowly, when details of the treatment by Dr. Dougall with 
gurjun oil reached me. I at once tried the application of the bal- 
sam unmixed with any other ingredients, with the happy result of 
closing the deep ulcers which had been festering for months; but as 
I had to leave the station soon, 1 lost sight of the patient. 
On my return to Beigaum, I gladly accepted the offer of Rever- 
end G. T. Bridges, S. J., the Roman Catholic Chaplain, to treat the 
lepers now under his charge, and they have been under my charge 
from July, 1876, to November, 1878. 
Twenty-nine cases were treated, 1-8 males, 11 females, of these 
these, three were children under 14 or 15 years, two females and 
one male; four were under 25 years, one female, three males; and 
the rest above 25 and under 45 years of age. Of the total number 
of cases treated, including those from the outside, two were Brah- 
mins and one Jain, who were in good circumstances of life, two of 
them being Karkoons, and one a grain merchant, one Mussalman, 
and the rest Hindus of the lower classes. In many of them there 
was leprosy in the family, such as father and son were leprous, and 
brother and sister in another instance. A few of the patients attri- 
buted it to marriage with leprous subjects; whilst in a few either 
there appeared to be a reluctance to acknowledge that the disease 
was hereditary, or that no cause could be assigned; the disease 
appearing de novo after a general failure in health, or accidental 
injury to the hands or feet while cutting something, or walking along a 
rough gravelly ground, and the wound thus caused becoming the 
seat of the disease. .Several patients suffered from both the tuber- 68 
cular and anaesthetic forms at the same time. In some it was asso- 
ciated with syphilis. The disease, as is generally attributed, was 
not traceable to the consumption of fish; fish being not so easily 
procurable in Belgaum; while in the three high caste Hindu patients 
it was quite out of the question, as they never eat fish. No particu- 
lar kind of diet, in fact, can be said to give rise to this disease. 
The patients, generally, complained of dyspepsia, attended with a 
burning sensation in the procardial region, voracious or capricious 
appetite which is not easily satisfied, and want of sleep at night, 
(Note. "These prominent symptoms are not generally described in 
books,'*) besides general malaise pains and ache in the joints and 
different parts of the body, resembling chronic rheumatism, attended 
with feverishness, and among those who were very much debilitated, 
diarrhoea and dysentry prevailed. In some advanced cases lung 
complications, attended with high fever, were present; probably due 
to tubercules (leprous) forming in the lung tissue, and terminating 
fatally. In one case an attack of high fever was followed by the 
permanent development of brownish-black spots all over the trunk 
as far as the waist. One patient who had ulceration of the throat, 
and whose voice was reduced to a whisper, suffered frequently from 
fits resembling spasmodic croup, which yielded to the administration 
of iodide of potassium in combination with ether and ammonia. 
The amount of amesthesis present in the fingers and toes rendered 
them liable to be burned with fire while cooking, or they were knawn 
by rats at night, without their owners being aware of it at the time. 
My plan of treatment has been, first to make the patients rub 
carbolic acid and sweet oil, (1 in 40) early in the morning for a 
couple of hours all over the body, and then bathe at about 9 o'clock 
with soap and warm water. Afterwards to rub an emulsion of gur- 
jun oil (made according to Dr. Dougall's formula, viz., gurjun oil 
one part, lime water three parts, churned, so as to form a thin oint- 
ment of a creamy consistence) over the affected parts, and fill in the 
ulcerations with the cotton wool smeared with the emulsion. The 
ulcers healed rapidly, but the anaesthetic parts and tubercules 
remained much the same; and except in one or two instances, where 
it was alleged by the patients that the tubercules were softening, I 
noticed no change in them. 
This induced me to try the cashew nut oil which has been so suc- 
cessful in the hands of Dr. Beauperthy. 
The result of my trial was so far satisfactory that some of the 69 
oldest patients, who had no hope of being ever relieved in the slight- 
est degree, took to it hardily, in spite of the pain and discomfort 
arising from the blisters which the application of this oil over exten- 
sive surfaces gave rise to; and on seeing that they were benefitted 
they sent for their friends, not in the asylum, and placed them under 
treatment. 
Briefly, then, I have used externally,- 
(1) as a general application, carbolic oil (1 in 40) rubbed over 
the whole body to promote healthy action of the skin, followed by 
soap and warm water ablution; 
(2) for the ulcerated parts, an emulsion of gurjun oil and lime 
water (1 in 3) applied by means of cotton wool and bandage, as 
well as by friction ; 
(3) for the anaesthetic parts and tubercular growths the applica- 
tion of cashewnut oil. 
Internally-chalmogra oil in five minim doses in combination with 
bi-carbdnate of soda, five grains, and peppermint water, one ounce, 
and, in particular cases, iodide of potassium in three grain doses. 
I shall now' briefly consider the remedies used: - 
1.-Gurjun Oil. I used this for a time, both internally and 
externally, as recommended by Dr. Dougall, but I was obliged to 
give up its internal administration in consequence of its ill effects 
upon the digestive system. In some cases it aggravated the symp- 
of indigestion, which I find is invariably present in leprous subjects, 
whilst in others it gave rise to diarrhoea ; and I did not consider it 
desirable to weaken the strength of the patients by continuing its 
administration while we have a much better remedy in chalmogra 
oil, especially as the weaker patients were liable to attacks of diar- 
rhoea and dysentery. 
As an external application, however, gurjun oil is very valuable in 
the treatment of chronic leprous ulcers, which heal rapidly under its 
action; and I do not remember seeing in any single instance the 
cicatrices open out w'hen it has been discontinued, although fresh 
ulcers break out in other parts of the limbs, which are similarly 
healed under its use. 
This emulsion also keeps the skin in a soft condition, and so pre- 
vents cracking, which is often the commencement of an inveterate 
ulcer. It has, moreover, the advantage of keeping away flies which 
infest leprous patients, and in the absence of cleanliness, give rise 
to maggots, which increase the extent of the ulcer, but under its use 70 
the lepers, as well as their rooms, presented a very clean appear- 
ance. 
As a proof of its efficacy, it may be stated that the patients 
always asked for more of this emulsion than the quantity they were 
allowed. 
Not only in leprosy, but in chronic (scaly) skin diseases, the gur- 
jun oil seems to be a very valuable remedy applied as an emulsion 
in combination with lime water. It is, besides, a cheap article of 
commerce. 
The advantages of gurjun oil, then, are the following:- 
(1) Its rapidly healing action on chronic leprous ulcers. 
(2) Softens the skin. 
(3) Prevents the collection of flies. 
(4) Its cheapness. 
(5) Its efficacy in the treatment of chronic skin diseases. 
I may here mention that, made into an ointment with sulphur, 
gurjun oil rapidly cures certain skin diseases, such as tinea circinata^ 
which are due to the presence of fungus. 
2.-Cashewnut Oil. In this we have a potent remedy for the dis- 
persion of tubercules. I was induced to try this, as gurjun oil did not 
give any satisfactory results. It is applied with a feather daily over the 
tubercules until blisters are formed, when it is discontinued. This 
causes the tubercules to soften and disappear, discharging in some 
cases an ichorous matter, and leaving an open ulcer. To the ulcer- 
ated surface thus formed the gurjun oil emulsion is applied, under 
which it cicatrizes rapidly. 
The application of cashewnut oil has to be repeated when the skin 
has healed. Until total absorption of the tubercules has taken 
place, care should be taken that it does not run over the healthy 
skin, or into the eyes. 
3.-Chalmogra. Oil. I find this oil most useful as an internal 
remedy, inasmuch as it acts as an alterative stimulant tonic, given 
in combination with carbonate of soda and peppermint water. It 
relieves the distressing burning sensation in the stomach arising 
from dyspepsia, and the constant morbid craving for food of which 
lepers generally complain ; at the same time it improves the appetite 
and promotes digestion, and thus leads to the healthy assimilation of 
food. Some of the patients who have been in the habit of taking 
alcoholic stimulants have asserted that they experienced a similar 
effect from its use, and for these reasons, combined with its not an 71 
unpleasant taste, they preferred it to gurjun oil. Chalmogra oil, 
moreover, has a direct influence in reducing the tubercules, as seen 
in cases where cashewnut oil had not been applied, and is therefore 
particularly adapted in the treatment of leprosy. 
4.-Carbolic Oil. I have used carbolic acid in combination with 
sweet or cocoanut oil as a general application with a view to promote 
the healthy action of the skiri, and also as a substitute for gurjun 
oil when I have not had a supply of the latter; but it is more expen- 
sive and less efficacious than gurjun oil. 
5.-Iodide of Potassium. I have used it with advantage, espe- 
cially in those cases which were associated with a syphilitic taint, 
and I believe it promotes the absorption of the newly-formed effu- 
sion of the peculiar substance from the different structures. 
Diet.-The patients in the asylum received rice and dall as their 
principal meal. Mutton once a week, and occasionally fresh fish. 
Potatoes and some of the ordinary country vegetables were also 
allowed, but they were forbidden to take brinjals, pumpkin and salt- 
fish, or meat of any description. 
During the famine, the quality of food was very inferior, as good 
grain was not procurable in the bazaar, except at very high prices, 
and this would require greater funds than were available; the asy- 
lum being kept up by local contributions collected monthly by the 
Roman Catholic chaplain for its support. Owing to the deteriora- 
tion in the quality of food, several of the inmates suffered from an 
aggravation of the symptoms during the famine months. 
Concluding Remarks.-After what has been described in the fore- 
going pages of this report, it will appear that, although gurjun oil 
has no specific curative effect on leprosy, it certainly does ameliorate 
the condition of the poor lepers, combined -with the other remedies 
detailed above; but, in order that they should receive the full bene- 
fit of medical treatment, it is highly desirable that some central asy- 
lums should be opened by Government where the patients could be 
brought more fully under medical supervision, where sanitary rules 
could be better enforced, and the diet better regulated than in any 
private asylum. 
Judging from Mr. McCorkhill's figures, there were not less than 
22.8 per cent, of population, in the Belgaum Districts alone, afflicted 
with some form or other of leprosy; and considering that it is a dis- 
ease which is liable to be transmitted from father to son, and propa- 
gated by marriage, it calls urgently for the adoption of such meas- 72 
ures as will not only palliate, if not entirely remove, the suffer- 
ing of the afflicted, but in all probability prevent the spread of this 
loathsome disease. 
I am indebted to G. McCorkhill, Esq., C. S., for the following 
statistics of leprosy in the Belgaum Districts from the census of 
1872:- 
In this collectorate, the total number of those disabled by infirm- 
ity is 4,131, or 44 per cent., or 44 per cent, of the entire popula- 
tion. The proportion of male infirmities to female is 60.8 to 39.2. 
Of the total number of infirm, 61.2 per cent, are either deaf, dumb 
or blind; and 22.8 per cent, are affected with one or other type of 
leprosy. 
NOTES OF CASES TREATED. 
In Dr. II. Vandyke Carter's paper on leprosy, an abstract of fif- 
teen cases is given from notes takes in 1876 and 1877, and certified 
by Dr. Peters. A few of these cases are as follows, three of the 
patients, subsequent to marked improvement, dying of diarrhoea:- 
Case I.-Aikous Sarson, nine years in the Leper's Home (1876). 111 20 
years; body covered with brownish-black patches, which are anaesthetic; 
lingers and toes contracted. The knee-joints and wrists more or less stiff, 
and has been a cripple for years. The disease first commenced in white 
and brownish-black patches on the thigh; while in the asylum live years 
ago had a violent attack of fever, which subsided on a rash breaking out 
over the whole of the body which still covers the trunk. 
Treatment.-The eashewnut oil was applied along the knee-joints, and 
the contracted lingers and the ulcers healed with gurjun oil emulsion. He 
has been able since to walk better and go over a mile to the Roman Catho- 
lic Chapel. 
This man who has been the oldest inmate of the asylum, was a great 
sceptic, and would not take any medicines at first, but seeing that his com- 
rades were improving, he took to treatment, and even went so far as to 
apply the eashewnut oil all over the legs and thighs, not minding the 
blisters caused thereby. He then sent for his son, who was born a year 
before the disease first broke out in him, and was at this time suffering 
from amesthem patches, like his father, on different parts of the body, to 
place him under treatment. 73 
This man is reported to have died during the famine season. 
Case 11.-Luxmon. Leprosy for ten years, and in the home for eight, 
(1876). 
Nostrils affected; tips of fingers and toes destroyed. No hair in the eye- 
brows, but that of the head and face good. Had three sores on the sole of 
right foot, six on the left foot; of these, two in the left and one in the right 
have now closed under the use of gurjun oil ointment. The largest and the 
oldest one is nearly healed; a small ulcer, however, has recently appeared 
on the left foot. Had tubercules over both arms, which have now dis- 
appeared. States that sensation has returned in the left foot, but that the 
right foot and both arms are still more or less anaesthetic. 
14th October, 1877. Fresh sores on the left foot; the old ones have 
healed. 22nd November, 1877. Sores almost healed. 
Case HI.-Kanuba. Ill seven years; four years in the home, (1876). 
Six months after treatment commenced the sore on the left ankle was 
nearly healed, that on the right ankle was contracting; tubercules in the 
lobes of the ears very much less, and face improved in appearance. 
18th October, 1877. Old sores on the left foot perfectly healed; new sores 
formed on the right foot. 
Case IV.-Isram Parub. Two years in home, (1876). Has three ulcers 
on right foot and one on the left, one on the left hand; fingers of the right 
hand contracted; left hand partially so. All the toes are contracted; could 
not walk on account of stiffness of the knee-joints. Has been applying 
ing the cashewnut oil to the joints and the gurjun oil over the sores, and 
can now walk great distances. All but one sore completely healed; the one 
remaining open appears to be connected with a piece of diseased bone in 
the dorsum of the foot. 
14th October, 1877. Sore in the right wrist healed. There is a burn 
mark on the left hand middle finger, caused accidentally by fire. Right foot 
still troublesome on account of the diseased piece of bone. 
Case V.-Yellappa. Right leg was first affected. There are anaesthetic 
patches scattered all over the body. Tips of three fingers of the left hand 
ulcerated and contracted. Ankle-joints stiff, to which cashewnut oil has 
been applied. There was a sore over the left thigh for nearly a year; gur- 
jun oil was applied, and it has closed since. Feels lighter generally. 
Remark.-This man died in September, 1877, during the famine. He is 
stated to have suffered from chronic diarrhoea. 
Case VI.-Poonajee. Four years in the home. Ill seven years; disease 
first appeared in the calf of right leg. Left eye destroyed by the growth of 
tubercules two years ago, (1876). There are tubercules in the forehead and 
cheeks; fingers swollen; legs also swollen and ulcerated. 
The big ulcer in the calf of the right leg healed, but fresh ulcers broke 
out in the feet, and the patient died of diarrhoea in July, or August, 1877, 
during the famine. 
Case VIII.-Purasnam, aged about 25 years. Ill eight years. In the 
home two years, (1876); father's father suffered from leprosy. 74 
Left foot, right hand, left hand, right foot, became successively affected, 
which are ulcerated. 
Six months after the use of the gurjun oil emulsion, some of the sores of 
the feet had healed, another was healing, but a Anger in each hand was 
ulcerated, and two phalanges have been exposed for a month. These came 
away eventually, and the ulcer closed. 
14th October, 1877. Ilas suffered for nearly two months and a half with 
an excessive gangrenous ulceration of the left fore-arm, from whence a 
large sphacelus has separated, lie was very low, and his strength has to be 
kept up with stimulants while the ulcer was dressed with gurjun oil emul- 
sion. The patient is now well and able to use his arm and move about. A 
deep cicatrix now marks the spot. 
23rd November. 1877. Has walked over himself about a mile's distance 
to my house. No more sores iu the feet, hands and arms. Quite free from 
sores. 
Case X.-Krishnee. Ill ten years. In the female asylum four years. 
Father had leprosy; died four years ago. Used bitter neem leaves (arader- 
achta in die a) both internally and externally. Has lost all the fingers some 
Ave or six years ago, some of them were eaten by rats. 
lias got a sore at the sole of the right foot. There is loss of sensation 
in the extremities. 
The sore very nearly healed, and sensibility had returned at the extremi- 
ties to such an extent as to enable her to feel the pain if anything got into 
the sore of her foot while walking. 
Case XI.-Gunga has been in the female asylum for five or six years. 
Became afflicted with leprosy shortly after her marriage some five or six 
years ago. Child died three days after birth. 
Face and hands slightly affected, but the legs have chronic ulcers, one in 
particular over the skin, which, she says, has been in existence for several 
years. 
In this very interesting case all the sores healed under the use of gurjun 
oil, including the old ulcer over the skin; and up to the time that I was in 
Belgaum, (November, 1878) no fresh ulcers had formed. 
Case XV.-Jairam Loobroo, aged about 25 years, ill about four years. 
Father's mother had leprosy, sister also leprous, and now in the female asy- 
lum. 
Had syphilis; tubercules on the cheeks, lobes of the ears and glans penis. 
Hands and feet anaesthetic, commenced with a papular eruption over the 
hands and feet, then the face. 
Treated himself with lemon oil and kapila powder (powdered nux vomica 
seeds) without avail. 
N. B.-Nux Vomica seeds powdered are given with lemon juice in dys- 
pepsia to promote the appetite and increase the digestive power. Under 
treatment the skin assumed a healthy appearance; the tubercules remained 
much the same. 75 
DR. DOUGALL'S TREATMENT WITH GURJUN OIL. 
Dr. Dougall, M. D., Surgeon-Major, Officiating Senior Medical 
Officer, Port Blair, in his Medical Report of April, 1874, presents 
24 cases treated by him in six months. He says, "As to the thera- 
peutic value of gurjun oil in the treatment of leprosy, I can only 
speak from my own observation here, as I never heard and nowhere 
read of it being used in this disease ; and in fact the only medicinal 
use I had read of it being applied to was in cases of gonorrhoea, 
where it is said to act like copaiba. Of the 24 cases under treat- 
ment here during the past six months, every one of them has 
decidedly benefitted by its use, every ulcer without exception has 
healed up and not broken out again, but the most marked benefit 
has been derived by those suffering from the anaesthetic form of the 
disease/' 
The plan of treatment is thus described by Dr. Dougall:- 
"They turn out at daylight (say 5.30 a. m.), after a little time 
they supply themselves with a small quantity of dry earth finely 
pulverised, which is kept ready in a tub under the hospital; with 
this dry earth they all proceed to a small stream in the neighborhood 
where they thoroughly wash themselves using the dry earth as a 
detergent; having accomplished this task, they return to the leper 
ward by 7 a. m., where they sit in a rowr, and each man is then 
served with his morning dose of 4 drachms of wood-oil and lime 
water mixed in equal proportions. Having seen this swallowed by 
all of them, the apothecary sees that each man has some small 
vessel (usually half of a cocoanut shell) into which the compounder 
puts a quantity of the gurjun ointment, and with this they proceed 
to rub themselves all over, not merely by smearing it on, but thor- 
ough and continuous friction is kept up for two hours, and the com- 
pounder all the while is walking up and down the line armed with a 
tin of the ointment and a spatula for distributing more of it as it is 
required amongst the patients, and no limit is placed upon the 
amount given further than that whatever is given must be well 
rubbed in. The rubbing is thus continued till 9 a. m. , then the men 
set about getting their food, and latterly they trim the ground 76 
around their own quarters and excavate earth-work, and it is pleas- 
ing to see the will with which men who for years had not been able 
to handle a walking stick on account of loss of fingers and numb- 
ness in the arms now set about this sort of work, and they are evi- 
dently proud of being again able to work, when such a hope had 
been abandoned long ago. 
At 3 p. m., the lepers fall in and get their second dose of half 
ounce of the gurjun emulsion internally and then the gurjun oint- 
ment is supplied to them as in the morning as already described; 
the rubbing is kept up from 3 to 5 p. m. The prolonged rubbing is 
not only insisted on for the sake of the action of the ointment upon 
the skin, but because I consider any gentle employment combined 
with exercise is beneficial both physically and mentally: by physical 
exercise the whole system is improved in tone, and the mind is bene- 
fitted by their attention being withdrawn from their former hopeless 
condition and they are led to compare the present with their past. 
The preparation referred to above is made as follows: Lime 
water, 3 parts; gurjun oil, 1 part; mix and agitate them violently 
until they thoroughly unite and form a substance of the consistence 
of Indian butter. This I have named gurjun ointment. At the 
same time I prepared a thinner mixture for internal use composed of 
equal parts of lime water and gurjun oil, and this combination is 
not disagreeable to the palate; and although the lepers now get half 
ounce doses of the emulsion night and morning, they constantly ask 
for more. 
The change the tubercules undergo in the process of reduction is 
worthy of notice. After the lapse of some time the tubercle seems 
to become more moveable and loose at the base and it is felt to be 
softer there than at the apex, this softening process gradually 
approaches the surface and at last a watery bleb forms, and this bleb 
soon bursts and allows a thin serous, clear fluid to escape, and a 
marked diminution is then observed as regards the size of the tuber- 
cle as compared with its former dimensions. This may take place 
two or three times, until the tubercle is quite reduced. I found it 
expedited matters very much to puncture these watery vesicles with 
the point of a lancet, and it allowed the fluid to escape without pain 
or inconvenience to the patient and did not interfere with the rubbing 
process. I have seen a tubercle on helix of ear entirely subside 
after one formation of this vesicle. 
The gurjun ointment, though thoroughly rubbed on the surface of 77 
the body for four hours every day, produces no vesications directly 
from its action and causes no pain whatever. It seems to be through 
its constitutional effects that the tubercules soften from within out- 
wards. I have rubbed it over my own arm, and it did not cause the 
slightest pain or redness though allowed to remain on all night. 
The emulsion is not disagreeable to the palate, and at first it had 
no well marked influence upon the digestive system ; but when the 
dose was increased to one drachm twice a day it improved the appetite 
and at the same time acted as a mild laxative. 
It has also a distinct diuretic effect; and. the larger dose (4 
drachms) twice a day caused several large healthy motions, in fact 
acted as a powerful diuretic and evacuant. 
The duration of the present investigation was arbitrarily limited 
by myself to 6 months. The time has been long enough to show 
that leprosy, both tubercular and anaesthetic, cannot only be arrested, 
but the condition of the lepers can be greatly ameliorated; and men 
here who have not for years been able to do more than drag out a 
a miserable helpless existence are now able and willing to work, and 
every sore is quite healed. In some instances the sores have been 
healed up for more than three months and show no tendency to 
reopen; and these desirable results have been attained simply by 
the use of gurjun oil and lime water, substances which are so cheap 
as to be within the reach of all. 
No change whatever has been made even in the most minute parti- 
cular in regard to the diet of the lepers from what they have been 
getting for years past, and they get their fish four times a week as 
usual. I always thought and still consider the men underfed, still I 
made no change in order to avoid complications and to test the gur- 
jun oil on its merits. It is not the lime that has the beneficial effect, 
because the improvement commenced before the lime was given at 
all, and has continued in cases where only the oil and lime water 
mixture was given. 
Any medicine that can ameliorate the condition of the lepers 
throughout the various countries where the disease exists is not less 
likely to be brought into common use because it is cheap, easily pre- 
pared and applied, and the supply inexhaustible, and many poor 
lepers may be able to use these preparations who might find it diffi- 
cult to obtain a liberal diet, fresh meat, milk, wine and foot-baths 
of hot cocoanut oil with the skilled attendant and his thermometer to 
look after the temperature. None of the above are required in this 78 
plan of treatment. I have had the lepers washed daily with water 
and dry earth, using the dry earth not only because it is cheaper 
than bran or soap, but because it is a better detergent than either. 
The gurjun ointment keeps well, especially when uot too freely 
exposed in bulk to the atmosphere, because the Co2 in the air is apt 
to convert a small portion of the Ca H2 02 into Ca Co3 X H2 O. I 
keep it in here a large jar with a wrooden lid. 
TREATMENT AT BANKOORA JAIL. 
Babu R. M. Banerjee, Superintendent of Bankoora Jail, (July 
25th, 1885), says: "In the time pf one of my predecessors, oil of 
garjan was chiefly used, both internally and externally; but it was 
given up, and arsenic was substituted in its place, and nim oil is 
rubbed externally; I am in the habit of giving them arsenic in the 
following combination: Arsenic, 60 gr. ; sulphate of iron, GO gr. ; 
with extract of gentian, which is divided into 60 pills and one to be 
given twice a day after meals." 
EXTRACTS 
FROM A REPORT BY T. R. LEWIS, M. B., AND D. D. CUNNINGHAM, M. B., 
SPECIAL ASSISTANTS TO THE SANITARY COMMISSIONER WITH THE 
GOVERNMENT OF INDIA, 1877. 
The report of these gentlemen was based upon clinical observa- 
tions made at the Almora Leper Asylum, and investigations in the 
Kumaun District. In the asylum eighty lepers were subjected to the 
closest scrutiny; 49 proved to be cases in which anaesthesia pre- 
sented the most prominent feature; 12 in which the presence of 
tubercules in the skin was the most marked peculiarity; in 15 cases 79 
the two former conditions were so equally evident that they were 
classified as "mixed;" and in 4 cases an eruption formed the most 
pronounced symptoms. The ratios which these yield agree generally 
with the proportion in which the different varieties of the disease 
have been observed to occur in other countries. 
The average age at which the outset of the disease was observed 
was found to be between 23 and 24 years; even the decimals obtain- 
ed by calculating averages in the case of male and female lepers 
were found to be almost identical. There "was, however, a range of 
from 3 years to 60. The average duration of the disease was nearly 
14 years. The form in which anaesthesia was the prevailing feature 
was the most chronic, the average duration of the " tuberculated " 
cases being shorter by nearly six years. 
The history of the asylum gives no support to the doctrine that 
leprosy is a contagious disease, but strong evidence to the contrary. 
The reverse has been stated with regard to the history of the asylum, 
but it will have been seen, from the information elicited, that not 
the slightest foundation existed for such a statement. 
But with reference to the probable influence of heredity in the 
propagation of leprosy, the facts elicited and which may, we believe, 
be accepted as trustworthy, give forth no uncertain sound. There 
can, we think, be no very substantial argument adduced in the face 
of the figures which have been collected in connection with this asy- 
lum alone to contra-indicate the influence that hereditary taint exer- 
cises a most important influence in the transmission of the pest. 
Taking into consideration, therefore, the prominent part undoubt- 
edly played by heredity, and the fact that the disease but seldom 
manifests itself until after puberty, it is evident that any attempt 
at "stamping it out" by the compulsory segregation of leprous per- 
sons would prove wholly impracticable; for, it would not only be 
necessary to segregate those suffering from developed disease, but 
also those hereditarily disposed to it. How, and by whom, could 
the predisposition be determined? It would, indeed, be even more 
important to secure the latter class, and such persons as are only 
manifestly affected to a slight extent; for it -would appear that per- 
sons of this description furnish by far the greater portion of the 
children who are, so to speak, potentially leprous,-time and circum- 
stance alone being required for the development of the disease. 
In intimate relation with this question is that of the probability or 
otherwise of an increase in the prevalence of the disease amongst 80 
such leprous community as exists in Kumaun. Fortunately it 
would appear that, pan passu, with the active manifestation of the 
disease, a tendency to sterility is also induced; moreover, the morta- 
lity among the children of lepers (even among such of them as are 
born before leprosy has manifested itself in the parents) appears to 
be abnormally high, so that the probable aggregate number of the 
offspring of lepers is to a very appreciable degree less than that 
furnished by non-leprous individuals. It is therefore evident that 
unles there be influences other than heredity at work in the locality, 
tending towards the production of the leprous condition, no serious 
increment need be apprehended. 
Leprosy in Ancient India. The disease has been known to exist 
in India for at least 3,000 years, but comparatively little was 
definitely known regarding its localisation in the various parts of the 
country until the results of the censuses of 1872 had been published. 
Very important advances have, within the last few years, been made 
in the acquisition of knowledge regarding the pathology of leprosy ; 
but with regard to our definite knowledge of its actual causation, it 
is to be feared that we have not, except phraseologically, advanced 
very much on the etiological views recorded by Atreya many cen- 
turies B. C., which were to the following effect: "When the seven 
elements of the body become vitiated through the irritation of the 
wind, the bile and the phlegm, they affect the skin, the flesh, the 
spittle, and the other humours of the body. These seven are the 
causes respectively of the seven varieties of kushta, (leprosy)." 
Atreya L, who is supposed to have lived probably nearly 2,000 years B. 
C. continues in the charaka sanpita on the pathology of leprosy. 
"The kushta thus produced cause much pain and suffering. None of 
these varieties result, however, from the vitiation of a single humour. 
Kushtas are of seven, of eleven, or a larger number of a kind; and these 
constantly irritating the system become incurable. We shall give a brief 
account of these as they are produced by the vitiation of the different 
humours. The wind, the bile, and the phlegm, being vitiated, re-act on 
the skin. &c. When the wind is most vitiated it produces the kapala kushta, 
the bile the audumbara, the phlegm the mandala, the wind and the bile the 
rishyajihva, the bile and the phlegm and the wind the sidhma, and the three 
together the kakanaka. 
Excessive physical exercise after exposure to too much heat or too much 
cold; taking food after surfeit; eating of fish with milk; using barley with 
several other grains, such as hayanaka, dalaka. karodusa, &c., along with 
venison, milk, eurdled-milk and butter-milk; excessive sexual intercourse; 
long protracted excessive fear or labor; fatigue, interruption of catarrh, 81 
&c., vitiate the phlegm, the bile and the wind; lienee the skin and the three 
others become slackened. Thus irritated, the three elements corrupt the 
skin and others, and produce kushta. 
The premonitory symptoms of kushta are as follow: want or excess of 
perspiration, roughness, discolouration, itching and insensibility of the 
skin, pain, horripilation, eruption and excessive pain on the parts that are 
about to fall off. 
Some kushta eruptions are red, rough, spreading and small; they cause 
horripilation, slight itching, pain, and discharge of matter and sanies. 
These are caused by wind, and are called kapala kushta^ (scaly). 
Those that are of a coppery colour, which discharge matter, blood and 
sanies, cause itching pain, inflammation and burning, and produce worms, 
are also caused by wind. They appear like the ripe tig, and are hence 
called audumbara^ (tig like). 
Some are cold to the touch, raised, hard, reddish-white, clammy, itching 
and infested with worms. These two are caused by wind; they are called 
mandala (circular). 
Those which are rough, red, white, yellow, blue or coppery, producing 
itching pain, worms, burning sensation, and insensibility, are also caused 
by wind. They have the appearance of the tongue of an antelope, and are 
hence called rishy ajihva. 
Those which are white or red, spreading and elevated; which discharge 
blood, pus and sanies, and produce itching, are also caused by wind. They 
appear like the leaves of the white lotus, and hence are called paundarika. 
Those that are rough, red, thin, internally cold, sometimes reddish-white, 
which cause slight pain, itching, burning, and discharge of pus and sanies, 
are also caused by wind. They appear like the flowers of the pumpkin and 
are called sidhma. 
Katnaka and others have all the symptoms of kushta. They are incura- 
ble, while others are curable. That which is incurable can never be cured, 
and those which are curable sometimes become incurable. 
The wind causes coppery-red, roughness, pain, inflammation, shrinking, 
horripilation, and insensibility of the skin. The bile produces burning, 
perspiration, pain, discharge of blood, and suppuration. The phlegm 
causes whiteness, coldness, itching, and confluent pimples. 
The worms that form in leprous eruptions destroy the flesh, skin, veins, 
muscles and bones. When affected by them, the patient suffers from sponta- 
neous discharges of blood, insensibility, loss of sensibility of the skin, 
mortification, thirst, fever, dysentery, burning, weakness, disrelish and 
indigestion. Then kushta becomes incurable. The man who neglects the 
disease at its commencement is sure to die. He, who at the first breaking 
out of the disease tries to get rid of it, may be sure of its being cured. 82 
PREVENTION OF LEPROSY BY SEGREGATION. 
BY BRIGADE-SURGEON H. V. CARTER, M. D., 1884. 
The following brief memoir is the third I have compiled for sub- 
mission to the authorities of British India; and, like its first prede- 
cessor, it is based upon unique experience acquired through the 
enlightened proceedings of the Government of Norway. 
By the kindness of Dr. G. A. Hansen, the able Superintendent of 
of the Leper Department, 1 am enabled to offer the latest known 
statistical data; and by the courtesy of the Director of the Civil 
Medical Service in Norway, 1 have been supplied with a series of 
reports in continuation of those described in my earliest communica- 
tion to the India Oilice, 1873. Since 1875, some changes in these 
have been made; and in future, only quinquennial reports will be 
issued: the next being due in 1885. 
Considering afresh the information thus accruing, 1 propose, in 
the interests of India, to discuss: (1) The present state of the 
leper question in Norway; (2) the probable explanation of amend- 
ments noted ; and, (3) Hygienic measures suitable for India. Au 
illustrated note on the pathology of leprosy is also subjoined. 
PART I. 
PRESENT STATE 0E THE LEPER QUESTION IN NORWAY. 
The methodical isolation of lepers has, during the past 25 years, 
been carried on with unremitting effort; the result being a decided 
diminution of the sick throughout this period. On initiation of the 
restrictive measures sanctioned, it was not anticipated that marked 
effects would quickly follow; and hence no dissatisfaction is 83 
expressed at the moderate and gradual amendment which has ensued. 
Recognizing from the first the incurability of leprosy, the State 
limited its attempts to opposing the hitherto continuous reproduction 
of disease; and such anticipatory sphere of action admits only of 
radical rather than showy achievements. How much longer these 
somewhat costly measures may have to be maintained cannot yet be 
said; but it has been learnt that restrictive means ought, if possi- 
ble, to be extended, and could be remitted only at imminent risk of 
renewed spreading of disease. 
Registration of the affected being an essential preliminary', I note 
that properly it includes, besides an enumeration of the lepers, a 
due record of their history and movements. In Norway the district 
medical men have always been aided, under express injunction, by 
"all clerical and secular officials and functionaries'' of Govern- 
ment ; and the peasantry not opposing, it might be expected that the 
yearly register would be fairly exact. In this matter, however, pre- 
cision is everything; and it has long been apparent that so simple a 
result as a strictly accurate list of lepers is hard to be obtained. 
Thus the malady in question begins obscurely and proceeds slowly; 
it seldom early disables; being at first set down as a blemish, it is 
disregarded by patients and'their friends; and since, in addition, 
many bad subjects purposely evade registration, it results that of 
the "fresh addition" brought to light year by year only 1-6 are 
"new cases" of quite recent origin, whilst 5-6 are entered as 
" overlooked " cases dating back 2, 3 or several years to the begin- 
ning of illness. As to the possible number of such latent residua, 
Dr. Loberg, in 1870, liberally estimated them at 300 (vide my first 
report, p. 17) ; whereas by the adjusted tables of 1880 it appears 
there must have been then at least 500 unrecognised or undetected 
lepers in the country, or one-quarter more in excess of the 2,050 
actually known. This datum illustrates the difficulties of registra- 
tion which are met with in Norway, and which also, I may add, 
obtain in Western India; since e. g., instead of the census (1871) 
number of 158, I found there were at least 472 lepers existing in 
Kdthi4wdr during 1876, most of whom had of course been overlooked 
(yide Kathiawar Report, p. 65). The Norse Tables show separately 
the number of asylum inmates (duly known and named) and of 
home-dwelling sick (only approximately ascertained) ; these com- 
bined numbers furnishing a plain total, which, for convenience, is 
added in column 10 of the statement below. Such ordinary enumer- 84 
ation is not, however, of more than very limited value; and in 1870 
the tables supplied an adjusted list of lepers, combining in addition 
the numbers who, to judge from their aspect and ascertained duration 
of illness, must for varying periods have been all along living unre- 
gistered in the country districts. 
Such numbers are still considerable-ex. gr. On comparing the 
list below, column 3, with a later one for 1881, I have been privately 
favoured with, it appears that during this last year alone no fewer 
than 74 "overlooked" cases were found which had to be incorpor- 
ated with the figures in the preceding year's list at dates correspond- 
ing with the beginning of illness as follows:-17 of 2 years' dura- 
tion, 17 of 3 years', 10 of 4 years', 2 of 5 years', 4 of G years', 8 
of 7 years', 3 of 8 years', 1 of 9 years', 1 of 10 years', and so on; 
4 being referred back so far as 25 years. Besides these, there were 
16 strictly "new" cases brought to light in 1881: the total "fresh 
additions" (as I here use the term) in that year amounting, there- 
fore, to 90. The latest issued table in the amended form is the one 
for 1880, which is copied below in columns 1 to 9 inclusive:- Year. 
Total at Be- 
ginning of 
Year. 
New 
Cases. 
Diminution both In and Out- 
side Asylums. 
Remaining at End 
of Year. 
Total at end of 
Year. 
Total at end of 
Year, by old 
Enumeration. 
Died. 
Dischargd 
Cured. 
At Home. 
In Asylum 
Column 1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
1856.... 
2.628 
235 
2.863 
2.113 
1857 ••• 
2,863 
242 
293 
is 
2 
2.367 
427 
2,794 
2.060 
1858.... 
2,794 
235 
225 
4 
2 
2.323 
475 
2,798 
2,082 
1859 
2.798 
249 
213 
8 
7 
2.296 
523 
2,819 
2.095 
1860 
2,819 
226 
253 
' 9 
2 
2.242 
539 
2,781 
2,068 
1861 
2,781 
246 
238 
14 
4 
2,060 
711 
2.771 
2.096 
1862 
2.771 
201 
212 
12 
4 
2.046 
698 
2.744 
2.119 
1863 
2,744 
189 
195 
6 
4 
1,979 
749 
2,728 
2.162 
1864.... 
2.728 
213 
202 
9 
1 
1,948 
781 
2.729 
2.182 
1865 
2.729 
200 
205 
9 
5 
1.938 
77^ 
2,710 
2.136 
1866 
2.710 
220 
213 
10 
3 
1,909 
795 
2.704 
2.126 
1867 
2,704 
185 
182 
7 
5 
1.898 
787 
2,685 
2.137 
1868 
2,685 
215 
211 
7 
6 
1,888 
788 
2,676 
2.119 
1869 
2,676 
167 
200 
16 
8 
1.832 
787 
2.619 
2.104 
1870 
2,619 
160 
230 
13 
3 
1.769 
764 
2,533 
2.055 
1871.... 
2.533 
153 
238 
16 
3 
1.682 
747 
2,429 
1,987 
1872 
2.429 
126 
205 
9 
5 
1,628 
708 
2.336 
1,943 
1873.... 
2,336 
122 
177 
18 
8 
1,583 
672 
2,255 
1.874 
1874 •••• 
2,255 
135 
183 
10 
5 
1,549 
643 
2,192 
1,832 
1875 
2.192 
123 
203 
14 
5 
1.470 
623 
2.093 
1,771 
1876.... 
2.093 
110 
187 
6 
2 
1,395 
613 
2.008 
1,731 
1877-... 
2.008 
90 
165 
7 
3 
1.294 
629 
1.923 
1.704 
1878.... 
1,923 
90 
139 
10 
9 
1.237 
618 
1.855 
1,681 
1879.... 
1.855 
39 
162 
11 
4 
1.115 
602 
1.717 
1,642 
1880.... 
1,717 
29 
150 
7 
7 
965 
617 
1,582 
1,606 
Tabular Statement of the Number and Movements of all the Lepers known in Norway during the Tears 1856-1880 inclusive. 86 
REMARKS ON THE ABOVE TABLE 
The headings of the several columns mostly explain for them- 
selves. Only the figures in columns 4 (deaths), 5 and 6 (discharged 
and cured), and in column 8 (asylum inmates), are certain and 
fixed ; all the other numbers being approximate, or liable to rectifi- 
cation in course of time. 
A.-DECLINE OF LEPROSY. 
This fundamental point is capable of being established in various 
ways. Thus, according to the enumeration in column 10, at the end 
of 1856 there were known 2,113 lepers, and in 1880 only 1,606: 
showing a diminution of 507 in the course of 25 years. But if (as 
in the adjusted lists) all overlooked cases whose duration dated 2 or 
more years back be added in their due place, there must have been 
at least 2,863 lepers (wide column 9) in 1856; and in the succeeding 
years a corresponding number gradually declining until the latest, 
when the same annual enumeration is found in both columns-the 
small difference here of 24 referring to lepers sent to the asylums 
without ever being registered in the country districts. According to 
the new reckoning, therefore, the total decline of lepers amounts to 
1,281; but this estimate probably is nearly as excessive as the other 
was defective, because no allowance is made for cases still remain- 
ing undetected in 1880. What the precise decline of leprosy has 
been cannot indeed yet be learnt, ami strictly not until the demise of 
every leper in the country will it be ascertainable: this drawback 
being inherent to the exacter method of registration. Probably the 
diminution has amounted tonear 1,000, or about one-third of the 
total known in 1856 ; and this would be a very notable result to 
attain in so short a time. 
Confirmation of the opinion now expressed, is the following:- 
According to the above tabular statement the total of new cases 
(column 3) has been 3,965, while the total outgoings (colums 4, 5 
and 6) have amounted to 5,246, leaving a deficiency of 1,281, which 
being far too considerable to be attributed to oversight becomes 
explicable only on the inference of a real decline of disease. Again, 
some details of column 3 not here shown, are, I find, very signifi- 
cant: thus, in former years there were about 250 "fresh additions" 
annually registered, now only about 130; of these upwards of 100 
used to be of quite recent origin, whilst now only 25 in the mean are 
"new" cases. And although successive years might vary, yet 87 
registration continuing at least as efficient as ever, this datum 
becomes conclusive of real amendment; and that in the best possi- 
ble direction. So also the following:-The proportion of "new 
cases" to total " fresh additions " used to be 40 per cent., the 
remainder being made up of "overlooked" cases of more or less 
prolonged duration; whereas now only 16 per cent.: that some over- 
looked cases will hereafter come to light is inevitable, but it is of 
good augury that these already form the very large majority of fresh 
additions, the strictly new cases becoming both relatively and abso- 
lutely smaller by degrees, and indubitably less. 
Lastly, some indirect evidence may be adduced. Relying on the 
immutable figures in column 4, I note that the mean annual deaths 
of lepers is now 180 instead of 244 as formerly ; whence, on the pre- 
sumption that the leprous disease has remained unchanged, it 
becomes evident there are now fewer subjects affected by it. 
According to column 10, the annual death-rate has declined from 
14.2 per cent, in 1857 to 9.3 per cent, in 1880; and there being no 
proof or belief in Norway (so far as I am aware) that the pest is in 
character so much less severe or fatal now than formerly as these 
two ratios would imply, it follows that in earlier years there were 
more lepers living than are entered in column 10: those entered in 
the amended column 9, with a nearly uniform death-rate throughout 
of 9 per cent., giving manifestly the correcter estimate. Suppos- 
ing, therefore, leprosy to be in Norway the same scourge now as 
ever, on this basis I reckon there may have taken place a diminution 
of about 30 per cent, in the total number of its victims. 
The above data, in general, concur; and there being none to my 
knowledge adverse, the point in question must be regarded as 
affirmed. 
B.-MOVEMENTS AMONGST THE LEPER COMMUNITY: COLUMNS 4, 5 AND 6. 
COLUMN 4, MORTALITY. 
For the whole 25 years the mean annual deaths are 202 ; of late 
about IGO only, of which 87 in asylums and 73 in the districts. 
Formerly, when the aillicted were more numerous, the deaths also 
were commoner and rather most frequent in the districts. The mean 
death-rate of leprosy in Norway is 8-9 per cent, per annum: 
amongst the incarcerated (who include the worst and most advanced 
cases) the mean death-rate rises to 9.14 per cent, per annum, w'hilst 
among home-dwelling sick it may be estimated at 5.7 per cent, per 88 
annum. For many years past there has not occurred any marked or 
progressive change in the mean death-rates; thus, in 1862 that of 
asylums was 13 per cent, and of districts under 6 per cent., whilst 
in 1880 the former was 11.3 per cent, and the latter also under 6 
per cent. The greater range among asylum inmates than outside 
these institutions is owing, as appears, to occasional brief outbreaks 
of local sickness (see below). 
column 5. 
In the mean about 10 subjects yearly leave the asylums uncured, 
or outside become lost sight of; equal to about A per cent, of the 
totals known. In Norway, as elsewhere, lepers are subject to home- 
yearning, secretiveness and impatience of control; but there are 
fewer facilities for evasion or decamping here, than would be in 
India. 
COLUMN 6, THE HEALED. 
The Norwegian authorities have always candidly recognized and 
published a paucity of results under this heading, which of itself 
betokens the present hopelessness of a cure for leprosy, and the 
need of sole reliance on preventive measures, for mitigation of this 
scourge. In the table are entered only 107 as healed, the total 
annual mean being 4 or 5 cases reported from both districts and asy- 
lums; equal to 1.63 per cent, of grand total of lepers 6,918, or 
yearly less than | per cent. Nevertheless, the systematic use of 
drugs is practised in the asylums, and particularly in Lungegaard 
Hospital under charge of the venerable Dr. Danielssen, where are 
admitted cases specially adapted for early and energetic treatment. 
It appears from reports that most recommended remedies have been 
fairly tried, yet without any uniformly successful result; and some 
partial mitigation of suffering is as yet all that drugs can effect. I 
also note that the detailed tables have a column for cases relapsing 
into sickness after 'healing' ; and from observation everywhere, it is 
known that the more prominent marks of disease may spontaneously 
subside, more or less, and remain in a quasi latent state for several 
months, or years. In confirmed cases, some evidence of the infec- 
tion may at all times be detected ; so that ' cure ' becomes a provi- 
sional expression. And, lastly, I see in these European documents 
a reflex of Indian experience; in the occasional disappearance of 
skin disease termed leprous, but really of a different and more 
amenable character. 89 
C.-THE ISOLATED AND NON-ISOLATED : COLUMNS 7 AND 8. COLUMN 7, 
HOME-DWELLERS. 
Necessarily, from their large numbers, all lepers in the country could 
not be relegated to asylums; but the aim has been to isolate as many 
as practicable under existing conditions. The result is, according 
to the table, that the series of district-residents is a steadily dimin- 
ishing one, now amounting to only 37 per cent, of its earliest sum. 
At successive decennial periods the numbers in columns 7 were as 
follows:-1860, at home 2,242 or about 80 per cent, of total lepers 
then known; in 1870, at home 1,769 equal to about 70 per cent.; 
and in 1880, at their homes 965 or about 61 per cent, of all afflicted 
then known. By the year 1885 it is anticipated that 50 per cent., 
or one-half the entire leper-community, will be isolated; and by 
1895 it is hoped that 75 per cent, may be so separated, leaving only 
25 per cent, at unrestricted liberty amongst healthy persons. That 
there really has taken place this most desirable diminution in the 
number of free home-dwelling sick is shown inferentially by the 
lessened proportion of deaths therein occurring; thus, whilst during 
1860-70 the numbers dying both within and without asylums were 
nearly identical, during 1870-80 the proportion of asylum-deaths 
rose to 71.6 per cent, and that of district-deaths sank to 28.4 per 
cent, of total declining loss of life from leprosy in Norway is due 
solely to lessening of home-mortality; and the smaller this becomes, 
obviously the better for the common weal. 
COLUMN 8, THE IMMURED. 
In a population of any size the amount of asylum-accommodation 
must be so limited, that only a part of all lepers can be segregated 
from the sound. In Norway, three large and two smaller institu- 
tions-of which three at Bergen and two further north-comprise 
the valuable means of isolation; capacity equal to lodgment of 800 
sick: total population of'country about 2,000,000, total lepers still 
near 2,000. The minimum of incarcerated was 235 in 1856, the 
maximum 759 ten years later; and thence a slow decline to 617 in 
1880. This decline is not due to lessening of accommodation, but 
to persistent unwillingness of the peasantry to send in their sick ; 
and I learn it is now contemplated to seek more compulsory legal 
powers of segregating lepers, if not in the asylums then at their 
own homes. That a real and continuous progress of isolation has, 
however, already been affected is evident:-thus, at first in 1856, 90 
only about 8 per cent, of sick were immured; in 1860, the figures 
were 539 in 2,781, or 19 per cent. ; and in 1870 they had risen to 
764 in 2,533, equal to 30 per cent. In 1880 the figures were 617 in 
1,582, or 39 per cent.; but this datum is an uncorrected one, and it 
may be that the ratio of immured to free has not of late much 
increased. If this surmise be as correct as it seems there is, I would 
remark, additional reason to urge isolation at home in aid of the 
more public means. The numbers yearly admitted into the asylums 
during the past 20 years has varied from 173 to 112: during the last 
quinquennium it has been about 125, a minute proportion of these 
being due to transfer and re-admisions. The outgoing by disease 
amongst the immured also varies, their occasionally happening brief 
epidemics of erysipelas, pneumonia or diarrhoea, though such signs 
of 'hospitalism' are not, I think, commoner in Leper-Asylums than 
in other collections of sick persons. Further details regarding these 
institutions will be found in my earlier report; and here I will only 
add that amongst their inmates there is commonly a slight predomin- 
ance of women (319 females to 298 males in 1880) ; whilst outside, 
men are most numerous-843 males to 763 females in 1880. 
PART II. 
PROBABLE EXPLANATION OF AMENDMENTS NOTED. 
According to the preceding Section, in Norway there has of late 
years occurred a distinct decline in the number of lepers, and this 
under opposite conditions; namely, on the one hand a continuous 
production of new cases, and on the other a large effacing death- 
rate. A third important condition, however, intervenes ; and that is, 
the complete isolation of a large proportion of the affected persons. 
Other possible agents in the amelioration noted will also be alluded 
to below. 
In limine, I should state that the ' cure ' of leprosy by purely 
medical treatment has not practically contributed anything towards 
obliteration of the disease. To rely, therefore, for a general amend- 
ment upon any of the varied remedial measures often confidently 91 
put forward would be to indulge in fallacies hurtful as well as decep- 
tive, and to encourage a kind of anticipation hitherto shown by 
experience to be futile. 
Next, that the disease is subsiding from a ' natural ' cessation of 
its growth seems to be disproved by the following consideration:- 
Supposing no re-production of the malady, its decline would be 
much quicker than is now happening; for with a death-rate of 10 
per cent, per annum the 2,863 cases alive in 1856 would in the 
course of 7 years have been reduced about one-half and at the end 
of 14 years to about 650, and so on, till, at the end of 25 years, 
there would remain only about 200 lepers, whose mean age would 
not be less than 60 years-assuming the mean age at starting to be 
35 years. In reality the rate of decline would be more rapid than 
this, because the death-rate rapidly rises with advancing years: thus 
the Norse Tables show that not less than 40 per cent, of all lepers 
die between 31 and 50 years of age, 17.2 per cent, dying earlier 
at 21-30 years. But the same tables prove that there has not 
occurred any such rapid diminution of the pest; there now being 
known at least nine times as many lepers living as should be, on the 
hypothesis of a direct dying out of disease in the country. More- 
over, that leprosy in Norway really displays any natural tendency to 
subside is disproved by the researches of Dr. Hansen, (report of 
1880, pp. 17-8), who shows that in most of the affected districts the 
death-rate is not by any means in excess of the increase-rate; the 
very reverse, indeed, being the fact-which indicates that the 
natural tendency of leprosy is more or less rapidly to extend. 
Thirdly, the decline of disease might be attributed to mitigation 
of various hurtful agencies, popularly associated with its origin: e. 
g., to the lessened use of a fish diet, to a less harsh and insanitary 
mode of life, or to the extended cultivation of an originally noxious 
soil, or to some climatic improvement. But, whilst the coast-dwell- 
ing peasantry of Norway, in comparison with other (not all) coun- 
tries of Europe, have admittedly long dwelt in a backward hygienic 
condition, living much on fish and potatoes, intermarrying freely, 
and being subject to overcrowding during their long winters ; still, 
on the other hand, it is notorious that they are an unusually well- 
developed and long-lived race: and besides, individual lepers are, as 
often as others, even robust people. Generalized statements, there- 
fore, not sufficing to uphold the view suggested, it ought to be 
shown when and where hygienic improvements have had an exclu- 92 
sive • connection with the decline of leprous disease inside limited 
areas, often placed wide apart; as well as with its diminution during 
short periods of time. Evidence of this kind, however, I have not 
met with; and on further comparing the conditions under which 
leprosy now flourishes in other parts of the globe, I fail to find any 
cogent evidence that this disease is essentially dependent upon mal- 
hygienic states, resembling those long prevalent in Norway. Experi- 
ence here (as elsewhere), rather points to its dependence on personal 
conditions ; for where most abundant the disease is there it is most 
irregularly distributed: thus, amidst healthy spots in Norway there 
are adjoining ecclesiastical areas with about 2,000 people (all living 
under closely similar states and habits), where the number of lepers 
was known to vary as much as 80, 30 and 8-these figures being now 
reduced respectively to 17, 15 and 0, without any noteable change 
in population : and to attribute such striking local variations solely 
to widely operating agency seems to me both rash and, in the pre- 
sence of a closer acting influence, needless. Nor to my mind, any 
more satisfactory is the assumption of some vague individual predis- 
position amongst the affected. 
In his report for 1875, Dr. Hansen discusses this subject in the 
only suitable way, namely by reference to examples: he remarks 
(p. 60) that if mal-hygiene operated as a direct, or (through rousing 
hereditary taint) as an indirect cause of leprosy, there should before 
the asylums were erected have been proceeding a decided hygienic 
improvement, the effects of which were manifest just when the 
practice of isolation began; such improvement also ought to have 
preceded or attended, at least, the after course of disease ; hereditary 
influence, too, then being checked, as well as the spontaneous 
appearance of new cases. But of all this there is no evidence, the 
facts known tending rather to disproof. In more detail, the districts 
of Tromso and Trondhjem should present a remarkable picture of 
hygienic progress: thus, during 1857-60 little or no isolation and an 
advent of new cases in 1856-60 and 1861-65 almost identical of 352 
and 361 respectively-also no sign of hygienic advance; but in 
1861-65 there were sent 293 lepers into the asylums, and during the 
following 5 years the new cases declined by 37-a number almost 
precisely corresponding to the estimate, which might have been 
made from the prior rate of increase proportionate to number of 
home-dwellers. Is it imaginable, here, that any culture-amendment 
had then suddenly culminated and found expression? Next comes 93 
the fact that, in general, leprosy still continues to progress at its 
former ratio; which would show that hygienic changes, even if con- 
currently made, can have had little or no influence on the progress 
of the disease. And further, were hygiene (in the ordinary sense 
of the word) really so operative as is urged the isolation of lepers 
must offer scanty promise of good, as not itself materially lessening 
hurtful conditions; but this inference is contrary to other reasonable 
deductions. Some of the above remarks apply to hereditary influ- 
ence, as a source of leprous infection; for in not a few examples of 
local decline of disease submitted to analysis there has been found too 
prompt and decided an amelioration in families to permit of this 
slow-acting agency being regarded as mainly influential. And in 
sum, so far as appears to me, leprosis can be directly mitigated by 
dietetic, hygienic or climatic influences only to the same extent as, 
and no further than, the analogous chronic infections of man, known 
as syphilis and tuberculosis. 
Lastly, failing other explanation, it may be asked-if the decline 
of leprosy in Norway be not nearly connected with the practice of 
isolating the sick in the asylums erected for their use. These insti- 
tutions, I would remark, were originally intended, by segregating 
apart the more vigorous lepers of both sexes, to aid in checking 
the propagation of disease through marriage ; they were also meant to 
accommodate the worst cases, or those a burden to their friends; 
and to a minor extent they were to serve as hospitals for curative 
treatment. Though founded so far back as 1856, it has only of late 
become possible to estimate their influence over the general progress 
of this very chronic pest; and owing to the inevitable obstacles to 
correct registration alluded to in Part I., the data suitable for satisfac- 
tory analysis are still but limited. Dr. Hansen's observation in his 
quinquennial reports for 1875 and 1880 may, I think, be regarded as 
the earliest attempts scientifically made to determine the real effect 
of the isolation of lepers in a community: his main conclusions are 
summarized below. I have also considered the recorded opinion of 
preceding Norse physicians; and, on the whole, prefer the later 
view. In Part I. it is shown that leprosy is not declining simply by 
a process of dying out, but that there is continually taking place a 
certain reproduction of disease; and it is only when and where this 
last proceeds at a lesser rate than the death-loss that the pest can be 
said to be subsiding. A third condition, however, concurs; viz., a 
contemporary removal from the districts and isolation in asylums of 94 
many old and new cases of infection ; and the question now arises, 
how does this isolating process influence the others? or these failing, 
itself account for the amendment proved in Part I. ? Within the 
asylums there occurs a higher death-rate than outside, whilst in them 
no new cases can arise; on the other hand, in the country districts 
there obtains a lower death-rate, and here alone do new cases appear. 
The asylums serve as a means of partially evacuating the infected 
districts, abstracting particularly the worst examples of disease; 
and they are not necessarily, it might be said, otherwise concerned 
in the general progress of disease. But would such assertion be 
correct? Let it be agreed that to clearly comprehend the course of 
leprosy, attention must be directed to conditions obtaining in the 
districts; amongst which the chief one is the number of "new" 
cases which arise, proportionately to the total of "home-dwelling" 
sick: for if the accretion-rate of new cases exceed the death-rate of 
home-dwellers, then disease is on the increase; and vice versa. 
Now, in his report for 1875, Dr. Hansen shows that up to 1870, in 
only one easterly district had the death-rate exceeded the produc- 
tion-rate ; whilst everywhere else the accretion-rate was highest. 
There had everywhere been removals to the asylums, and hence a 
diminution of the mortality outside these institutions: still, had no 
such emptying of the districts taken place the death-rate would 
nowhere, with the exception named (itself doubtless open to expla- 
nation), have exceeded the production-rate, and the total of lepers 
in the districts at the close of 1870 would in all probability have 
been quite as great as in 185G-or "in some places unquestionably 
greater." Elaborate tables are given, from which it appears that 
the yearly increment of new cases in a district regularly declines 
just according to the larger number of lepers removed to the asy- 
lums. Thus, e. g., in Sogn-district, whilst these increments propor- 
tionately to the numbers living at home remain the same in 1856-60, 
1861-65, and 1866-70, yet by removal to asylums, the numbers at 
home being continuously reduced, there has occurred a concomitant 
reduction of new cases, as shown in the successive yearly sums of 
89, 64 and 59 ; which still display a definite and fixed ratio to the 
immediately preceding totals of home-dwellers. No exception to 
the above rule has been found; and from close and rigid scrutiny of 
the data alone, it seems clear that the diminution of new cases in the 
districts goes, pari passu, with the lessening number of home-dwell- 
ing sick: at least, amongst all the several data, no other relationship 
is so clear and invariable as this one. 95 
In his report for 1880, with matured statistics coming down to 
1875, Dr. Hansen is not less emphatic; and finding a determinate 
ratio between the number of new cases, and the immediately preceding 
number of home-dwelling lepers in a district (taking 5-yearly 
periods for each), he employs such ratio to make a .forecast of the 
future progress of leprosy in Norway. The particular data adduced 
in support of these views are certainly remarkable and seem to me 
adequate; they are, however, too elaborate for reproduction here.* 
Once more, it is shown that in Norway the proportionate growth 
of leprosy is by no means diminishing; and hence an inference 
that the conditions for extension of the disease, are in no way more 
unfavourably now than formerly. Since, therefore, the total of 
lepers is certainly lessening, this cannot be due to amendment (if 
any) in home-conditions; and the figures quoted are quite conclu- 
sive against the view that leprosy persists only as the result of ordi- 
nary mal-hygiene or a hurtful clime. In 1880, as previously, it is 
found that in the great majority of affected districts the death-rate 
of lepers lies below their increase-rate-the exceptions being one, or 
at most two, out of nine such districts; and as regards the other 
seven or eight, Dr. Hansen remarks the death-rate is so far below 
the production-rate, (viz., from 2 to 6 per cent, lower,) that the con- 
dition of these localities would have been most grievous had there 
not taken place a large emptying of the sick thence into the Asy- 
* Dr. Hansen's figures refer to separate districts in the total affected area. 
On analysis of column 3 (new cases) and column 7 (lepers at large) of the 
large table above, embracing the whole area, I find, after excludimg the 
incomplete data of later years, that during the earlier years 1856-70 inclu- 
sive, the annual ratio between new Cases and sick home-dwellers is, in the 
mair, very near 1 to 10. This implies the yearly advent of 1 new ease to 
every 10 lepers at large; which is a ratio larger than the mean death-rate of 
such lepers. Precise figures for the three included quinquennial periods, 
are successively as follows:-Mean annual number of lepers at large 2,371, 
of new cases 239 : 1,994 and 204; 1,859 and 177. Subsequently to 1870, the ratio 
of new cases gradually declines; doubtless because their numbers have not 
yet been sufficiently ascertained. These data might have been introduced 
into the text of Part I., but they were reserved for this place as confirming 
the inference of Dr. Hansen, who does not, however, (that I see) state his 
estimate to be the same as that here independently elicited. Whilst well 
aware that several conditions must intervene. I am still of opinion that 
here is evidence of a quite definite influence; and I agree with Dr. Hansen 
that the Norwegian statistics contain no more constant datum than this one, 
of a distinct proportion between lepers at large and the newly-made lepers. 96 
lums:-"Indeed, except Nordfjord, everywhere would the actual 
production-rate have been greater than ever before, without such 
prior isolation as has been available; and incomplete as this is and 
always has been, we may congratulate ourselves that it was practic- 
able, and ought to feel grateful to those who by their zealous labours 
for the public weal have effected the establishment of the existing 
Asylums" (p. 18). 
Briefly, analysis of the official statistics proves that the affected 
districts are becoming emptied of their sick, not by excess of deaths 
but by abstraction and isolation in Asylums and at home of many 
affected persons. Dr. Hansen also very reasonably adds that on the 
supposition of leprosy spreading by contagion, one can readily 
understand the disease may be subsiding generally, in spite of a 
sustained production-rate; since, consequent on removal to the Asy 
lums and on isolation at home there must necessarily remain at 
large a smaller number of contagion-bearers capable of infecting the 
hitherto sound. Indeed, except upon the hypothesis of contagion, 
no other explanation of events seems possible. 
Respecting the varying amount of disease, old and new, which 
prevails in individual areas, Dr. Hansen refers to the corresponding 
differences met with in abundance of the mild (smooth) and severe 
(nodular) forms of leprosis; showing in detail that where the worse 
form is commonest, there arise the largest proportion of new cases. 
Though somewhat recondite, this explanation I regard as probably 
valid. 
SUMMARY OF PART II. 
The amendment of public health under notice cannot be satisfac- 
rily accounted for by reference solely to a general improvement in 
diet, dwellings, soil or climate; nor has purely medical treatment 
ever proved curative; and so far from leprosy in Norway showing 
a natural tendency to subside, there is ample evidence of a present 
activity equal to that displayed by the disease 25 years ago. Some 
influence might, therefore, be assigned to the special measure of 
isolating lepers ; and, in point of fact, amongst all the available data, 
to none does amendment bear such definite relation-fixed or pro- 
gressive-as it does to that lessening of lepers at liberty which results 
from the practice of enforced isolation. 1 admit that demonstration 
of such essential relationship is to be had only through a perfect 
acquaintance with every detailed instance adduced; yet with present 
information, 1 submit the evidence is enough to prove its reality, and 97 
to indicate the true modus operands of leper-isolation as practised in 
Norway. More than a single beneficial influence may, indeed, be at 
work; but predominant is this exclusive dealing with the individual 
leper as himself the source of ill to others. So much being granted, 
it remains only to add that the transmission of personal ailment is 
necessarily effected either promptly by contagion, or slowly through 
communication to offspring-the intimate mode of transmission being 
essentially the same in either instance; and here, Nowegian experi- 
ence seems to indicate the usual predominance of contagion. 
PART III. 
PREVENTIVE MEASURES SUITABLE FOR INDIA. 
Both social and humanitarian motives would inculcate the system- 
atic relief of the leprous sick, whose malady to themselves is so 
grievous and abiding and to others so offensive or even hurtful. To 
all who recognise a claim thus founded, the experience patiently 
and not uncostly accruing in Norway must appear equally interest- 
ing and encouraging. Being scientifically acquired, the principles 
hereby evolved become applicable under conditions so widely diverse 
as those of Norway and India. First, as to country and clime, 
there is no reason whatever to suspect that leprosy anywhere differs 
in origin or nature, any more than it differs in signs, course of con- 
sequence ; and this consideration at once disposes of pre-conceivable 
objections to the best line of treatment being the same in both 
countries named. Analogy with other chronic diseases common to 
Europe and the East serves to confirm this view. Next, as to colla- 
teral circumstances, these are but subsidiary; only in India the peo- 
ple being subject, more ignorant, apathetic and prejudiced, it is for 
their leaders and the ruling powers to initiate the needful preventive 
measures, and to uphold these until by spread of knowledge and 
experience of good effected the public approval becomes assured. 
General treatment of the leprous as a peculiarly affected class 
may be either ordinary or stringent. Thus, the sick may be collected 98 
and dealt with as ordinary hospital patients; without, that is, regard 
to prevention or future amendments. Or, for permanent relief, they 
should be strictly isolated from the rest of the community, and 
amongst themselves the sexes kept apart-isolation of this kind 
being practicable at the homes of lepers, but better carried out in 
asylums. Evidently, this last method is the only one likely to check 
and lessen disease: it has, in Norway, proved to be beneficial in both 
these directions, as well as by awakening the people to a sense of 
rational self-help and a willingness to co-operate further. Such a 
cogent and attractive stimulus is much needed in India, where the 
foundations of public hygiene have yet to be laid. 
Segregation is practicable in three modes, either separately or 
combined:- 
1.-By erecting plain asylums at certain centres, each of which 
would be a refuge common to several districts; and a place of deten- 
tion, under due management and supervision. 
2.-By founding Leper Colonies or village communities mainly of 
the affected, who, while allowed more liberty of movement, should 
yet be prevented from mingling with the peasantry around: hence 
still the need of strict supervision. Many spots would thus serve- 
such as deserted forts, decayed villages, and places now waste yet 
not far from other sources of supply, or not without near resources 
easily resuscitated. 
3.-By requiring the strict isolation of leprous subjects retained 
in their homes at express wish of friends. Suitable separate lodg- 
ment would be indispensable ; unsuitable shelter is even now some- 
times supplied. Joining of such home-isolation with more public 
measures should not be overlooked; for to it experience in Norway 
seems to point as a means essential to complete success within a 
moderate period of time; and in India it would have to be still ifiore 
largely resorted to. 
For carrying out the above, in addition to funds, legislative 
authority is needed to take up the vagrant sick, to remove the sorely 
diseased who is insufficiently guarded at home, and at times to 
enforce continued isolation of the infected until medical sanction of 
liberty be granted. Such authoritative interference will, I am 
aware, be differently regarded by many and disliked by the masses; 
yet it cannot at present be dispensed with, and sufficient precedent 
exists in several British enactments against small-pox and contagious 
diseases of men and animals. Besides, as analogues, special insti- 99 
tutions already exist for the permanently disabled, the blind and the 
insane; also, in most civilized countries, for those incurable affected 
with cancer and consumption. At one time, indeed, asylums for 
lepers were common all over Europe, where now the disease gener- 
ally has become eradicated ; whilst Norway still presents a number 
of these peculiar establishments, adapted to modern requirements, 
and, as I have tried to show, not less than formerly of decided 
efficacy. 100 
APPENDIX. 
NOTE ON THE PATHOLOGY OF LEPROSY. 
I have long regarded this malady as one of the great chronic 
infective diseases of the human race; and such view I hold to be 
confirmed by Hansen's discovery that in leprous structures there is 
always to be found an algoid growth-a bacterium, which is absent 
from both healthy and differently diseased structures. In its fresh 
state I once saw this organism at Bergen (1873), and soon after at 
Bombay: and quite recently it has been repeatedly studied on the 
Continent of Europe. With the aid of new re-agents its presence is 
easily demonstrated; and I offer the appended illustration as an 
original one, corresponding closely with descriptions given of Euro- 
pean specimens. In June last I excised a small ' nodule ' from the 
arm of a leper; and after immediate hardening in alcohol made 
sections for double staining after Ehrlich's method. All these frag- 
ments show crowds of bacilli and several large collections of granules 
(? spores), which when untinted no doubt correspond to the " brown 
cells" figured as characteristic in Plate XII. of my large work on 
leprosy (London, 1874): besides, there are seen cells and nuclei 
belonging to the common tissues of the nodule. See Fig. 1. Here 
the patient was in fair health, the cutaneous eruption of several 
months standing, and quiescent or slowly subsiding. The minute 
organisms could not possibly have been accidently introduced; their 
number is immense, and they seem to be growing actively, the pro- 
ducts, doubtless, being eventually absorbed. As contrasted with 
the violent symptoms attending pathogenetic bacteria of acute infec- 
tions, the little irritation, local or general, commonly attending bacil- 
lus leprae, is remarkable; yet occasional exacerbations of disease do 
occur, during which there is fever and wide reproduction of the 
nodules; and thus the general analogy of leprosis to syphilis and 
tuberculosis becomes apparent. European observers have found 
both bacilli and spores in lymphatic glands and the blood; also in 
diseased nerve-trunks, liver, spleen and testes: the evidence of sys- 
temic infection being then complete. It is known that the organism 101 
will grow outside the body, and there is evidence that its germs 
(like those of tubercle) are freely given off from the persons of 
lepers; and by comparative experiment it is further ascertained that 
although general disease fails to appear, yet leprous material inocu- 
lated in animals slowly leads to a real-if imperfect-local repro- 
duction of the leprous processes taking place in man. As systemic 
infection with a visible eruption occurs only at prolonged and irre- 
gular intervals in him, in the lower animals (themselves possibly less 
fit subjects) these intervals may be so long as to require a year, or 
more, for such outward manifestation. At present, proof of conta- 
giousness of leprosy is mainly inferential; but further experiments 
may further positive data, like those now being acquired in the 
instance of tuberculosis, which so nearly resembles leprosis (vide 
large work, p. 176). This similitude holds good not only in a gen- 
eral clinical sense, but also as regards the attendant parasitic organ- 
ism ; and, in evidence, I have drawn some figures of the bacillus 
tuberculosus on the same scale as those of the lepra-growths: see 
Plate, Fig. 2. This second specimen was taken from the lung of a 
consumptive patient, who died in the J. J. Hospital: similar appear- 
ances have been seen in the sputa of other phthisical patients, and 
they correspond to English descriptions. The b. leprce I find to be 
usually shorter and more variable in dimensions-length 1-16000 to 
1-6000 in.; less bent, oftener bulging in centre and thinning at the 
ends ; oftener dotted in aspect or composed of distinct granules in 
linear series, the number and site of which differ considerably. The 
amount of small rods and signs of spore-production greatly exceed 
what has been seen in tuberculated tissues ; yet the general charac- 
ters and processes appear much alike in both sets of specimens. 
Other particular features as shown in the drawings, made as accu- 
rately as possible with the aid of a 1-10 in. water-immersion lens, 
eye-piece B, and achromatic condenser of Swift. 
(Signed) II. V. Carter, M. D., (Lond.) 
Bombay, November, 1883. 
By order of His Excellency the Bight Honourable the Governor 
in Council, 
J. Nugent, Secretary to Government. LEPROSY IN OTHER COUNTRIES. 
Answers to Questions Asked by the Hawaiian Government. 
QUESTION 1. 
1.-Is Leprosy known in ? If so, be pleased briefly to 
DESCRIBE IT AS IT OCCURS THERE. 
A.-Are THERE SEVERAL DIFFERENT forms or outward mani- 
festations of Leprosy? If so, by what name are they res- 
pectively KNOWN? 
B.-Are these several forms, in your opinion, only varieties 
OF one common morbid state? or are they specifically dis- 
tinct diseases, having no affinity with each other? 
C.-Please to enumerate succinctly the more obvious and 
distinguishing characters of each form of Leprosy which 
YOU HAVE SEEN. 
REPLIES. 
CANADA, (New Brunswick.)-It occurs there in the three par- 
ishes, Tracadie, Caraquet and Poukemouche which are situated on a 
peninsula between the Bay of Chaleurs and the Miramichi River. 
a. There are two forms; Tubercular and Anaesthetic Leprosy. 
b. These two forms are but varieties of a common morbid state. 
c. The tubercular form is distinguished by the presence of tuber- 
cules of various shapes and size which appear on the surface of the 
skin; most frequently on face. These tubercules enter atrophy or 
ulcerate.-Dr. J. E. Graham. 
Leprosy is known in the two counties of Gloucester and of North- 
umberland, in the north-eastern part of the Province of New 
Brunswick, in Canada; that section of the country borders the Baie 
des Chaleurs, the Gulf of St. Lawrence and the lower portion of the 
River Miramichi. 
Elephantiasis groecorum presentsitself in New Brunswick precisely 
as it does everywhere else, as a chronic disease of a specific charac- 
ter. It is manifested externally by insensibility, maculae and vari- 
ous extensive colorations of the skin, pemphigus, atrophy, alopecia 103 
(not generalized), ulcers and ulcerations, small tumours (tuber- 
cules), adenic troubles, pyretic accesses, loss of extremities and 
other disorders, some of which are peculiar to the disease, and some 
simply concomitant lesions of more or less frequent occurrence in 
the course of the malady, the whole ending by suffocation, syncope, 
coma, marasmus or cachexia. 
a. I have observed, in New Brunswick, what is meant by the 
words "tubercular leprosy" and "anaesthetic leprosy" of many 
authors, or by the words " phymatod leprosy," of other writers. 
What I have to say on this question applies also to other distinctions, 
made by not a few, under the various titles of " macular leprosy, 
lepra mutilans, " mixed leprosy," &c. All these classifications are 
based on the presence, absence or more or less conspicuous appear- 
ance of certain symptoms. 
b. These so-called forms, in my opinion, are the result of one 
common morbid state. 
Anaesthesia is invariably present, to a greater or lesser degree, in 
some part of the body, in all cases of leprosy; it is therefore diffi- 
cult to understand how it can be made to characterise any particular 
form. It was from the consideration of the uniform presence of the 
analgesic state in some portion of the accessible surface of the body 
of the leper that the College of Physicians of London, in their 
report on leprosy, proposed to substitute the term " non-tubercu- 
late" for the term " non-amesthetic." Tubercules are often times 
absent; but inasmuch as those small tumours are only one of the 
manifestations of a process which affects, not simply the skin, but also 
the nerve structures and other tissues, the absence or presence of 
these papules, at a given moment or at any time, seems hardly suffi- 
cient to warrant an addition to the nomenclature. All this, however, 
is said without losing sight of the great importance of that symp- 
tom. 
My answer to the second part of question b is easily surmised, 
from what I have already expressed. That which does not consti- 
tute, in my opinion, different forms of the distemper, cannot be for 
me "specifically distinct diseases, having no affinity with each 
other." Leprosy to my mind, is one indivisible morbid entity, so to 
speak, although, as in other ailments, its outward manifestations are 
not all produced in every case, and never to be all met together at 
a given moment, in the same individual. It is not, moreover, anms- 
thesia, maculae, pemphigus, tubercules, destruction of substance, 104 
which constitute per se the essence of leprosy ; these trophic lesions 
are seen in other diseases; they succeed traumatism of the nerves; 
they are produced on animals by nervous irritation. What charac- 
terises the disease is the specific labor which produces them, in the 
particular way they present themselves in this affection-to the 
medical observer in shape, color, odor, mode of evolution-to the 
medical philosopher in analogies, differences, causes, effects logically 
deduced from evidence and history. 
c. I have already given the more obvious characters of leprosy 
which I have seen; but 1 do not take any of them as distinguishing 
different forms of the disease. Most of the outward symptoms of 
leprosy are apt to be absent, to appear, disappear and reappear, 
succeeding and, as it were, supplanting each other, under the opera- 
tion of one specific irritative force, during the long course of the 
sickness. 1 opine, with all due deference for the opinions of others, 
that such a succession and change of phenomena, all due to the 
same exciting agency, constitute a morbid unity, and cannot establish 
a basis upon which these forms can be built. To burden the study 
of the disease with such distinctions and names, is I humbly but 
firmly hold, complicating matters, without any adequate compensa- 
tion, especially when attempts are made to carry these distinctions 
so far as to separately describe the progress of the disease through- 
out.-Dr. J. C. Tache. 
Leprosy has existed in the Province of New Brunswick, Canada, 
for many years. It is a specific disease, characterized by the slow 
development of nodular growths in connection with the skin, muc- 
ous membranes and nerves, and in the latter case, by the superven- 
tion of an,esthesia, and a tendency to ulcerative destruction. 
a. The tubercular and anaesthetic. 
&. I agree with Dr. Tache in his statement that these are varieties 
of one morbid state. 
c. The specific phenomena develop themselves according as the 
skin and mucous membrane on the one hand, or the nerves on the 
other, are principally affected; although in some cases all these 
tissues are implicated simultaneously or in succession.-Dr. A. C. 
Smith. 
CANARY ISLANDS.-Yes, since the conquest. Lepra tubercu- 
losa and Lepra mutilans. They are varieties of the same morbid 
condition and can be transmitted hereditarily.-Dr. A. Navarro 
Torrens. 105 
CEYLON.-True leprosy is known in Ceylon and has been recog- 
nized since the Dutch occupation of the islands. It exists in every 
form and phase, the .antesthetic being perhaps the most frequent 
among the fish-eating population on the seaboard and in Colombo, 
the chief city of the island. It is considered a constitutional disease 
sui generis, and occurs in the principal forms, which, in my opinion, 
are only varieties of one common morbid state.-Dr. W. R. Kynsey. 
GUATEMALA.-Yes; tuberculous, anaesthetic and one which is a 
combination of both of these. It is one and the same disease, with 
different symptoms.-Drs. Valladores and Yela. 
HONG KONG.-It does not prevail to any extent in this colony. 
There are cases amongst the lowest class of Chinese which, however, 
have not been treated by European practitioners.-Consul-Gen- 
eral Keswick. 
MEXICO.-There is in Mexico a malady known as the "Mal de 
S. Lfizaro," the symptoms of which correspond with the disease 
commonly known under the name of Elephantiasis Grcecorum, and 
which some European doctors have called leprosy. There are three 
forms, tuberculous, anaesthetic and macular. It is believed they are 
varieties of the same disease; they combine one with the other, two 
in one and the same individual.-Dr. J. M. Gomez. 
NETHERLANDS.-Leprosy occurs not only in the Netherlands 
but also in the East and West Indian Netherlands' possessions. The 
disease presents itself in the three forms of maculosa, tubercular 
and amesthetica. The persons in whom leprosy is observed in the 
Netherlands are such as have returned from the Indies. I have 
noticed unmistakeable symptoms of leprosy on such persons on land- 
ing and sometimes not till two years afterwards. In the East and 
West Indies leprosy is endemic but whilst the disease is of more fre- 
quent occurrence in the Moluccas than on the Island of Java, it is 
not epidemic in the latitudes first mentioned, the number of sufferers 
there being always very small.-Dr. J. van Deventer. 
NETHERLANDS, (Colonies.)-The disease appears in all parts 
of the Indian Archipelago except the little Sunder Islands and the 
northern part of Celeb, also in Surinam and Curaao.-Colonial 
Minister. 
(2) (Holland.)-Leprosy is rare in the Netherlands, and even 
then is almost invariably seen in persons coming from the colonies. 
Isolated cases are known in which the disease is hereditary.-S. Ege- 
ling. 106 
NORWAY.-Yes, there are two different forms of leprosy known 
by the names of glat spedalskhed (glet smooth spedalskhed leprosy) 
Elephantiasis lavis and kindred spedalskhed, (kindred knotty 
cumyry), Elephantiasis tuberculosa. These two forms are varieties 
of the same disease and are often found in the same person; the dis- 
ease beginning with one form and afterwards developing to the 
other. 
E. Lavis-spots, (maculae) of various sizes and shapes of a red- 
dish-purple color and often combined with the loss of feeling (anaes- 
thesia). 
E. Tuberculosa, knots or lumps (tuberculae) of the size of a pea 
to a Spanish nut, sometimes spread over various parts of the body, 
sometimes confluent to larger masses, especially in the eyebrow and 
other parts of the face.-Consul-General. 
SIAM.-Leprosy prevails but little in Siam, more so amongst the 
Chinese than Siamese population.-Consul Kurtzhalss. 
SPAIN.-Leprosy is rare in Spain and generally presents itself 
endemically and in the tuberculous form.-The Faculty. Barcelona. 
QUESTION 2. 
2.-At what age does the disease generally manifest itself, and 
WHAT ARE USUALLY THE EARLIEST SYMPTOMS OBSERVABLE? 
CANADA, (New Brunswick.)-May appear at any age; in Tra- 
cadie as young as eight, and as old as eighty. The earliest symp- 
toms are generally debility, pain in the limbs and occasionally fever, 
and general feeling of malaise. The appearance of maculae is gen- 
erally the earliest possible sign.-Dr. J. E. Graham. 
The disease generally manifests itself after puberty, in grown up 
adults and middle-aged individuals; but it comes at almost all ages; 
early infancy, however, seems to be entirely exempt from the 
malady. Children are not frequently attacked by leprosy, and it is 
rarely observed to begin in old age. 
The incipient symptoms are general uneasiness, drowsiness, irre- 
pressible instinctive anxiety, undefined and not very severe pains, 
KEPLIES. 107 
followed by hyperemia, hyperesthesia, insensibility, maculae, pem- 
phigus, atrophic manifestations and alopecia, especially of the eye- 
brows.-Dr. J. C. Tache. 
When resident physician I admitted boys of eight years of age, 
and one woman who was a septuagenarian. The disease, however, 
is chiefly confined to young adults. 
The premonitory symptoms often continue for a long period, and 
may include lassitude and depression, accompanied by a constant 
inclination to steep, even when at wrork; then follow pains in differ- 
ent parts of the body simulating rheumatism, and in turn followed 
by a train of symptoms described by Dr. Tachd in his reply to this 
question.-Dr. A. C. Smith. 
CANARY ISLANDS.-Between infancy and manhood and some- 
times even in infancy.-Dr. A. N. Torrens. 
CEYLON.-At all ages from childhood to advanced life. I have 
not seen children born with the disease but have observed anaesthetic 
leprosy in a child of three years, and well-marked tubercular leprosy 
in children of nine and eleven years. There is at present a female 
inmate in the asylum who has clearly manifested the disease in her 
fifty-seventh year, long after her two sons were affected with it. 
The earliest symptoms in the anaesthetic form are usually indica- 
tive of some nerve lesion as shooting or darting pains in the limbs, 
loss of morbidity of the fingers, burning sensations in the feet, 
formication all over the bodv followed some time after by loss of 
cutaneous sensibility, contraction of the little fingers and the appear- 
ance of tawny colored, benumbed spots on the face, trunks and 
limbs. 
In the tubercular form the premonitory symptoms generally 
observed are a feeling of malaise, unusual drowsiness, vertigo, epas- 
taxis, profuse sweating on the least exertion, the appearance of livid 
blotches attended with rigors, and tumefaction and thickening of 
the lobes of the ears. 
In well-marked mixed-leprosy, the fever and erythematous rash 
are generally associated with commencing numbness of the fingers 
or a benumbed discolored patch on the body and the occurrence of 
blebs on the extremities.-Dr. W. R. Kynsey. 
GUATEMALA.-The disease is most frequently met with between 
the age of twenty and forty. I have met with only two patients of 
tender age, one of six and one of seven years of age, but I have 
heard of two or three cases where the afflicted were twelve to fifteen 
years of age.-Drs. Valladores and Yela. 108 
MEXICO.-It generally appears from seven to thirty years of 
age, but there are cases in which it has appeared at forty and fifty. 
The first symptoms are, ordinarily, a cessation of the transpiration 
of the perspiration of the feet and legs with increased sweat on the 
rest of the body, dryness in the nasal fossoe and falling of the 
external part of the eyelids. Accompanying these phenomena are a 
burning sensation in the members and body and a little amesthesia. 
-Dr. J. M. Gomez. 
NETHERLANDS.-Leprosy shows itself among children as well 
as among adults. In the Indies the disease may last for five years 
then it ends fatally. In the Netherlands it continues much longer 
up to fifteen years.-Dr. J. van Deventer. 
NORWAY.-The disease generally manifests itself in the mature 
age, but appears also in children. The earliest symptoms are 
usually, a change in the person's temper and mind; a change in the 
features of the face and then the appearance of macuhe or tuber- 
cula.-Consul-General. 
SPAIN.-Lepers have presented themselves from twenty to forty 
years of age.-The Faculty. Barcelona. 
QUESTION 3. 
3.-At what period of life, and within what time, does the dis- 
ease USUALLY ATTAIN ITS FULL DEVELOPMENT? AND AT WHAT 
PERIOD OF LIFE, AND AFTER WHAT TIME, DOES IT USUALLY PROVE 
FATAL? 
CANADA, (New Brunswick.)-The disease usually develops in 
three or four years. It usually proves fatal in seven or eight years. 
-Dr. J. E. Graham. 
The period of life at which the disease attains its full develop- 
ment and at which it proves fatal, depends on the period at which it 
has made its first appearance, combined with the length of its sick- 
ness. The progress and duration of the malady vary very consider- 
ably : in some cases it destroys its victims in a few years, in other cases it 
lasts many years, and in a few cases a long period of time. I have not 
KEPLIES. 109 
yet sufficiently worked the problem to attempt to give an average, 
inasmuch as many considerations are to be had in the discrimination 
of the facts from which it would be logical to strike a fair mean. 
Women seem to be possessed of a greater power of resistance to the 
disease than men. Nine to twelve years are not an uncommon dura- 
tion in both sexes. There are instances of such a slow progress and 
of such an attenuated malignity of the ailment that life, and even 
general fair health, are enjoyed for many years. There are now 
living, in the Lazaretto of New Brunswick, two women who have 
had leprosy with a constant show, although at times somewhat 
obscure, of the characteristic symptoms, for the respective periods 
of at least forty-six and thirty years. In these two cases there are 
yet no signs observed of a profoundly impaired health, far less of a 
near destruction. A woman died a few days ago who had had the 
disease for twenty-two years. 
The development of leprosy can hardly be subjected to a regular 
exposition of stages, so capricious is it in its manifestations and 
duration; many of its symptoms are susceptible of complete disap- 
pearance and re-appearance as already stated. The ailment may be 
said to be in full development when some of its pathognomonic 
symptoms, and the process by which they are produced, are clearly 
discernable. I am led to believe that the time of invasion is to be 
counted by months, during which, and a long time after, the patient 
may ignore, or knowing, may conceal his situation, if he chooses to 
do so. As there are no sure rules to indicate the phases of the dis- 
ease, this obscurity, and the circumstances of the benignity of the 
first symptoms and of the persistency of the incipient trouble 
through the whole course of the sickness, have induced to assign an 
excessive length for the stage of invasion, that is, for that period of 
languor which is premonitory to the outward signs of the disease. 
Leprosy, however, may be said, grosso modo, to present three 
periods subsequent to the prodromic phases:-1st, the progressive 
period; 2nd, the sickly period; 3rd, the destructive period. The 
first may last a very long time, and may include series of pretty 
severe manifestations ; the second may indure for months or years, 
and offer frequent intermissions of accesses and comparative repose; 
the third is of comparatively short duration, which may, neverthe- 
less, mean more than a year. 
This division, which I venture, and the names I give to its periods 
are suggested to me by the character of the disease, its degrees 110 
being in reality, susceptible of distinction only when measured by 
the general results on the whole system.-Dr. J. C. Tache. 
This depends on the age and constitutional vigor of the individual. 
The duration of the anaesthetic variety seems to be much longer 
than that of the tubercular. In New Brunswick as elswhere, an 
essential feature in its life history is its extreme chronicity.-Dr. 
A. C. Smith. 
CANARY ISLANDS.-It generally reaches its full development 
at adolescence. It commonly terminates in death at the adult age or 
in incipient old age.-Dr. A. Navarro Torrens. 
CEYLON.-The disease attains its full development sooner or 
later, according to the circumstances and condition of the patient 
and the state of his general health. From 10 to 15 years is about 
the usual period; rarely the disease remains normally arrested for 
years. It usually proves fatal at middle age ; the longest duration 
of the disease recorded in the asylum for the tubercular form was 
16 years, anesthetic, 28 and mixed, 21 years.-Dr. W. R. Kynsey. 
GUATEMALA.-The development of the disease has no fixed 
time; the younger the patient, the more rapid the progress of the 
disease. As a rule, the disease terminates fatally in from four to 
eight years.-Drs. Valladores and Yela. 
MEXICO.-The greater number of cases occur in youth or at a 
mature age. The diseased who suffer from the macular form die 
within ten years, counting from the date of the appearance of the 
disease; those from the tuberculous within fifteen, and those with 
the anaesthetic may linger for thirty years or more.-Dr. J. M. 
Gomez. 
NETHERLANDS.-In the Indies it may last for five years and in 
the Netherlands for fifteen before its fatal termination.-Dr. J. van 
Deventer. 
NORWAY.-The disease attains its full development in the 
mature age.-Consul-General. 
SPAIN.-Cases are too few in number to form any exact opinion. 
-The Faculty Barcelona. 111 
QUESTION 4. 
4.-IS THE DISEASE MORE FREQUENT IN ONE SEX THAN IN THE OTHER? 
If so, in what proportion? 
CANADA, (New Brunswick).-The disease is as frequent in the 
male as in the female sex.-Dr. J. E. Graham. 
Leprosy is more frequent in men than in women. The proportion 
is not constant; it varies considerably from time to time, and evi- 
dently, from place to place; but there can be no doubt that the 
greater prevalence of leprosy among men than among women is one 
of the features of the disease.-Dr. J. C. Tache. 
It is much more frequent in the male.-Dr. A. C. Smith. 
.CANARY ISLANDS.-I believ-e it is equally frequent in both 
sexes.-Dr. A. Navarro Torrens. 
CEYLON.-This disease appears more often in men than in 
women in the proportion, based on the figures in the records of the 
asylum, of eight to one.-Dr. W. R. Kynsey. 
GUATEMALA.-Amongst men. Nine men to six women.-Drs. 
VALLADORES AND YELA. 
MEXICO.-More frequent in the masculine sex in the proportion 
of eight to five.-Dr. J. M. Gomez. 
NORWAY.-No.-Consul-General. 
SPAIN.-Apparently more frequent in males.-The Faculty. 
Barcelona. 
REPLIES. 
QUESTION 5. 
5.- IS IT MORE FREQUENT AMONG CERTAIN RACES? AMONG THE WHITE, 
THE COLORED, OR THE BLACK POPULATION? AND IN WHAT RELA- 
TIVE PROPORTIONS? 
REPLIES. 
CANADA, (New Brunswick.)-Not confined to any particular 
race.-Dr. J. E. Graham. 
It is historically proved that the disease attacks all races. In 112 
New Brunswick there have been lepers of French, Scotch, English 
and Irish descent, and lepers of mixed origin. I have had no occa- 
sion to personally observe the existence of the malady in other 
races, as there are none, or hardly any, of other blood in the coun- 
ties of Gloucester and Northumberland than the four mentioned, 
except Indians. The frequency of the disease does not, in my 
opinion, depend on race, but is proportionate to the exposure of the 
people to the causality of propagation. 
By far the greatest number of lepers in New Brunswick is counted 
among the French and the people of mixed origin, and for many 
years past the malady was, and is, exclusively limited to these two 
categories. The disease has become endemic only in five localities, 
namely:-Tracadie, Nigaouek, Pokmouche, Chipagan and Cara- 
quette, in which the French population is to all others as nine to 
one. There never was any case of leprosy among the Indians, 
although one of their principal villages is located in the endemic 
section, being contiguous to the parish of Nigaouek.-Dr. J. C. 
Tache. 
The disease is at present confined to persons of French descent. 
In former years several persons of other nationalties have been 
affected, doubtless through contagion.-Dr. A. C. Smith. 
CANARY ISLANDS.-1 have only seen it in individuals of the 
white or Caucasian race.-Dr. A. Navarro Torrens. 
CEYLON.-In this colony it is not exclusively confined to any 
community, but is more frequently observed among the Sinhalese 
and Taniis. Seldom among the Eurasians, and more rarely among 
Europeans.-Dr. W. R. Kynsey. 
GUATEMALA.-It is an almost unheard of thing for an Indian 
to be afflicted with leprosy; my patients have all been Ladinos. 
(Descendants of Spaniards and Indians).-Drs. Valladores and 
Yela. 
MEXICO.-No preference of this disease has been noted for any 
special race or color; except, it may be stated, that no negro with 
this disease has yet presented himself at this hospital.-Dr. J. M. 
Gomez. 
NETHERLANDS.-Leprosy is found equally amongst Europeans, 
Chinese, Arabs and native Indians.-Dr. J. van Deventer. 
NORWAY.-There is no colored population.-Consul-General. 113 
QUESTION 6. 
G.-In what condition of society is the disease of most frequent 
OCCURRENCE. AND WHAT ARE THE CIRCUMSTANCES WHICH SEEM 
TO FAVOR ITS DEVELOPMENT IN INDIVIDUALS, OR IN GROUPS OF 
INDIVIDUALS? 
Please to enumerate these circumstances under the fol- 
lowing heads :- 
A.-The character of the place or district where the dis- 
ease MOST FREQUENTLY OCCURS IN RESPECT OF ITS BEING URBAN 
OR RURAL, ON THE SEA-COAST OR INLAND, LOW, DAMP, AND MALA- 
RIAL, OR HILLY AND DRY. 
B.-The sanitary condition of the dwellings, and of their 
IMMEDIATE NEIGHBORHOOD. 
C.-The habits of life, as to personal cleanliness or other- 
wise. 
D.-The ordinary diet and general way of living. 
E - The occupation or employment. 
CANADA, (New Brunswick.)-It is of most frequent occurrence 
among people whose dwellings are small and unhealthy and whose 
food is poor in character. In Tracadie stale fish is eaten freely. 
a. It occurs frequently on the sea-coast and low, damp countries. 
b. In Tracadie sanitary condition bad; dwellings small and 
unhealthy. 
c. Not cleanly. Lazy and slovenly. 
d. Diet: potatoes, salt meat and stale fish ; very little change of 
diet. 
e. Farmers, fishermen.-Dr. J. E. Graham. 
The disease in New Brunswick, has occurred among the ordinary 
working classes of varied means, none of the families in which it 
has been met being in affluence and none in misery, all being pro- 
vided with the necessaries of life. The circumstances which favor the 
development of leprosy, in individuals, are the close intimacy of 
family life and the great sociability of the people. 
a. The places where the malady has occurred are rural, with one 
exception; all the places are upon the sea-coast or in close proximity 
to it. The interior of the counties of Gloucester and Northumber- 
land is not settled. The country is undulating, generally dry, 
well-drained, well-provided with good water and not at all malarial. 
REPLIES. 114 
b. The sanitary condition of the dwellings vary, and do not 
differ in their variety from those of the neighboring parishes, 
counties and provinces similarly situated. The dwellings of many 
of the affected families are good and well-disposed, others are not. 
The conditions of the immediate vicinity of the houses are very 
good as a rule. 
c. The habits of life are those generally met with among people 
of the same class and following the same occupations. The domes- 
tic and personal cleanliness vary; some are clean and some are not. 
d. The diet has always been good and abundant. The way of 
living, so far as it affects the moral and the physic of people, is 
better described by the results than by fanciful or prejudiced des- 
criptions ; the population is well-behaved, intelligent, laborious, 
remarkably healthy, robust and long lived; they are not subject to 
any widely prevalent disease of any kind. The natural increase of 
population, among these people, is exceptionally great. 
e. The ordinary occupations are farming, by far the most impor- 
tant, fishing and lumbering, and a mixture of them. All lepers 
have been from families connected with these occupations except 
one merchant, one the daughter of a miller and a few who belonged 
to the class of artisans. 
Several families were and are reduced, some very much, in cir- 
cumstances, on account of the existence of leprosy in their midst; 
the malady was, or is, the cause of the poverty, not the poverty of 
the malady. 
1 have said before that the Indians have been the only race, of 
those inhabiting these localities in any number, which have remained, 
so far, exempt from leprosy; it is well, then, to recite the conditions 
of their existence as connected with the purport of the question I 
am now answering. The places in which the Indians dwell bear 
precisely the same character as those inhabited by their neighbors, 
among whom the ailment has exercised its ravages. The occupa- 
tions of these aborigines are farming, on a very small scale indeed, 
fishing, hunting, lumbering and cognate interests; these people are 
provided with the necessaries of life; they are well-behaved, intelli- 
gent and uncommonly healthy, although not generally long lived; 
they are much more subject to scrofula and consumption than all 
the other races, and have no great power of resistance to sickness, 
as a rule; they do not increase in number: their dwellings ith few 
exceptions, arc very poor, much inferior, save such exceptions, to 115 
the very worst houses of the white population. In one word, their 
circumstances are, at best, equal and generally inferior to those of 
the poorer whites. The only reason I can see for the complete 
immunity they have enjoyed is that although friendly with the other 
races, they do not socially come in close intercourse or contact with 
them. Every, race, as a rule, keeps the closest company with their 
own blood, and the most intimate social relations are seen with the 
French amongst themselves.-Dr. J. C. Smith. 
During my residence in Tracadie, I observed that the disease 
appeared only among the poorer class. In one of my reports, I 
stated that " as the condition of the people improved, bringing with 
it a more nourishing diet, the disease would eventually disappear." 
Poverty, per se, cannot cause the disease, but, because of the 
depressing influence, it seems 'to favor its development in persons 
who are predisposed to it by hereditary taint. 
I fully agree with Dr. Tachd in his statement that "the circum- 
stances which favor the development of leprosy are the close inti- 
macy of family life and the great sociability of the people." 
a. Tracadie is on the sea-coast. 
b. The people are settled on farms ; consequently, the dwellings 
are isolated and healthy. 
c. The habits of life are good. The people are religious and 
marry young. 
d. There is now abundance of healthy food to be obtained. 
The indolent ones are, of course, the poorer ones, and their diet is 
seldom wholesome. I have frequently noticed that when such per- 
sons are ill from serious disease they readily succumb. 
e. Fishing and farming.-Dr. A. C. Smith. 
CANARY ISLANDS.-Sea-coast, and city and country, indiscri- 
minately, having at all times different conditions of soil. This 
diversity in the dwellings of lepers is in obedience, in my judgment, 
more to a conjunction of special circumstances than that the locali- 
ties favor the development of the disease, owing to the fact that it is 
not a common thing for them to leave the towns in which they 
originally established themselves, on account of the horror their 
miserable appearance inspired strangers to them, thus perpetuating 
in the places referred to, leprosy by heredity; I do not desire to be 
understood, by this observation, that I do not believe it to be possi- 
ble for leprosa to be spontaneous-since several cases of it have been 
recorded-but the rather to accentuate the importance which, in my 
opinion, heredity holds. 116 
1). The dwellings belonging to the poorer classes are generally 
unhealthy. 
c. Ordinarily, they have little personal cleanliness. 
d. The food usually consists of salted fish, baked or roasted ; maize 
roasted and ground into flour, which they eat in great quantities dry 
or kneaded with water, milk or herb broth; also baked potatoes and 
several kinds of vegetables. 
e. Some are fishermen but the greater part laborers. 
Among the predisposing causes are the severe changes of temper- 
ature, and the abrupt checking of sweat by sudden plunges into the 
water.-Dr. A. Navarro Torrens. 
CEYLON.-Chiefly among the poorer classes such as cultivators 
or field laborers, mechanics, cartdrivers, coolies or day laborers, 
fishermen and others whose occupation expose them to vicissitudes 
of weather and extremes of heat and cold. 
It occurs more frequently on the western and southern sea-board 
of the island and in Colombo, the chief city; on the banks of rivers 
and littoral lakes, in low, more or less damp malarial localities. 
Sanitation is not much observed among the poorer natives, whose 
dwellings are usually small thatched huts, ill-ventilated and crowded, 
with the immediate neighbourhood filthy and strewn with mouldy 
and rotten vegetation and excremental deposits; their clothing defi- 
cient; their diet poor from insufficiency of nitrogenuous elements, 
consisting chiefly of dry and salted or badly preserved fish, often in 
a rotten state, and inferior grain and vegetables; and their occupa- 
tion that of cultivators or coolies.-Dr. W. R. Kynsey. 
GUATEMALA.-On the sea-coast which is low, and in the depart- 
ment of Quezaltenango, which lays 6,000 feet above the level of the 
sea, and which is the coldest region of this republic, leprosy is but 
little seen. Near the capital, where the climate is very variable, is 
the spot where leprosy most exists. 
b. The dwellings are generally of adobe ; brick tiled. 
c. People of the lowest class, who live on the cheapest kind of 
food and give no attention to cleanliness. 
d. Plaintains, bananas, black beans, fried in lard. Work only 
when necessity compels them. 
e. Farm hands.-Drs. Valladores and Yela. 
MEXICO.-It afflicts almost entirely the poorer classes and gen- 
er ally [such persons as frequently expose themselves to moisture and 
heat alternately. 117 
a. It is most frequent in small populations and in the country, 
in places near to the coast, in the bays and in moist and marshy 
spots. 
b. The condition of the dwellings may have some influence. 
c. The habit of taking considerable alcohol appears to influence 
the development of the disease in persons predisposed to it. 
d. The larger number of cases are noted where pork is freely 
used for food. 
e. The lazars are mostly herders, out-door men, or laborers who 
are for the best part of their lives close to a fire and frequently 
exposed to the cold air and dampness.-Dr. J. M. Gomez. 
NETHERLANDS.-It is more prevalent on the sea-boards than in 
the mountain ranges. Dr. J. van Deventer. 
NORWAY.-Nearly only amongst the poorer classes. 
a. The disease appears only along the sea-coast and its imme- 
diate neighbourhood. The district is mostly hilly, rocky and dry. 
Malaria is not known in Norway. 
b. The sanitary condition of the dwellings is, as a rule, good. 
c. The personal cleanliness is not always as good as it ought to 
be. 
d. The ordinary diet is fish-often salt or dried, but seldom or 
never rotten, potato and porridge, prepared of barley-meal and 
water. 
e. Fishermen, sailors and small farmers.-Consul-General. 
7. -What condition or circumstances of life seem to accelerate 
OR AGGRAVATE THE DISEASE WHEN IT HAS ONCE MANIFESTED IT- 
SELF IN AN INDIVIDUAL? 
QUESTION 7. 
REPLIES. 
CANADA, (New Brunswick.)-Previously mentioned condition. 
-Dr. J. E. Graham. 
There are no conditions nor circumstances of life that seem to 
accelerate or aggravate per se the disease, beyond what applies to 
all ailments. Everything calculated to depress the moral or physi- 118 
cal forces renders the individual sick less able to resist the ravages 
of this malady, and, therefore, quickens its development and its 
fatal termination ; but the idea that the eating of a particular article 
of food, the use or non-usage of certain articles of habilment, can 
influence the production and spread of leprosy, is in my humble 
opinion, quite inadmissible. There are no more reasons, that I see, 
to attribute the disease to, or connect it with climate, dwellings, food 
or habits of. life, than there is as regards small-pox, syphilis, 
measles and other universal distempers, specific in their character; 
of course crowding, and all which favours close contact, necessarily 
multiply the risks of contagion and infection for all specific diseases, 
as well as isolation is a preventive against the spread of such ail- 
ments. I cannot take up here the question of common (not banal) 
causes possibly being factors in the spontaneous elaboration of 
viruses, nor can I here enter into the study of the theory of micro- 
organisms in connection with specific diseases.-Dr. J. C. Tacbe. 
/ Similar 'to Dr. Tachi's.-Dr. A. C. Smith. 
CANARY ISLANDS.-I know of no others than the lack of 
hygiene.-Dr. A. Navarro Torrens. 
CEYLON.-Insanitary and unhygienic conditions associated with 
intemperance, sexual excesses, neglect and exposure ; want of per- 
sonal cleanliness; improper treatment by native practitioners and the 
abuse of mercury and opium. Most of the patients admitted into 
the hospital with the disease in its most aggravated form had been 
previously salivated or were habitual opium eaters.-Dr. W. R. 
Kynsey. 
GUATEMALA.-Want of fresh air; the custom (amongst the 
poor class) of whole families sleeping in one room; want of cleanli- 
ness, and use of alcoholic liquors.-Drs. Valladores and Yela. 
MEXICO.-Abuses of all kinds; excess in eating and drinking, 
exposure to intense and cold encourage the symptoms of the disease 
and hasten its fatal termination.-Dr. J. M. Gomez. 
NORWAY.-Drunkenness and want aggravate the disease.-Con- 
sul-General. 119 
QUESTION 8. 
8.-Does the disease appear often to be hereditary? Have you 
known instances where one member only of a family has 
BEEN AFFECTED WHILE ALL THE OTHER MEMBERS REMAINED FREE 
FROM ANY TRACE OF IT? 
REPLIES. 
CANADA, (New Brunswick.)-It is apparently hereditary. It is 
doubtful as to whether it is really hereditary.-Dr. J. E. Graham. 
The disease does not appear to me to be hereditary, that is trans- 
mitted, de toutes pieces., from parents to offspring by procreation, or 
stored in the blood of individuals or generations, in its morbid 
nature and potential energy, without show of its presence. I doubt 
not, however, that the greater or lesser susceptibility to contract or 
acquire the distemper forms part of constitutional inheritance. 
Families may have received from parents and ancestors innate 
organic peculiarities, which render their members, or some, or 
many of them, not necessarily, but eventually, easier preys to the 
disease, when the exciting cause is brought, with effective force, to 
act upon them. 
I know many instances where one member only of a family has 
been affected with leprosy, while all the other members remained 
free from any trace of it. In this connection, it is not idle talk to 
remark that the mere fact of the appearance of several cases of a 
disease in one family is, prima facie, no more suggestive of heredi- 
tary than of contagious transmission. The significance of the occur- 
rence is a matter of medical and philosophical criticism, which has 
to consider the character of the malady, the order of time, and the 
circumstances and surroundings of each ease.-De. J. C. Tache. 
I am unable to adduce proofs of the hereditary nature of the dis- 
ease, but hold that the theories of hereditary transmission and conta- 
gion are not incompatible. The disease frequently skips over a 
generation. I have known many instances where one member only 
of a family was affected.-Dr. A. C. Smith. 
CANARY ISLANDS.-Hereditariness figures principally as the 
predisposing cause from first to last.-Dr. A. Navarro Torrens. 
CEYLON.-A hereditary taint is frequently admitted by the 
patients in the asylum and several instances are on record of one or 
two members of a family being affected while others remain exempt 
from any trace of the disease.-Dr. W. R. Kynsey. 120 
GUATEMALA.-Yes; I think it is often hereditary, but I know 
of three instances; two of which, in which the father, and one in 
which the mother were afflicted with leprosy. They cohabited ami 
the children are not diseased, but in one case the daughter's child 
had it. I am convinced that the disease w'ill appear in the second 
generation.-Drs. Valladores and Yela. 
MEXICO.-It is hereditary, and is assuredly transmitted by the 
mother: but if the mother is healthy it has not yet been determined 
how it is transmitted. I know' a family in which only one of its 
members has any symptoms of the anaesthetic form; the family con- 
sists of four persons. The father died of the disease, the mother is 
healthy.-Dr. J. M. Gomez. 
NETHERLANDS.-In the few' Indian Islands set apart for the 
treatment of lepers, the sufferers are living together. These lepers 
produce perfectly healthy children, out of whom are sometimes born 
leprous infants. This proves the hereditary tendency of leprosy at 
least in the form of atavism.-Dr. J. van Deventer. 
NORWAY.-The disease is very often hereditary. Yes, have 
known such instances.-Consul-General. 
SIAM.-The Siamese as w'ell as the Chinese assert that the dis- 
ease is hereditary but not catching, and are therefore not afraid of 
being near a leper.-Consul Kurtzhalss. 
QUESTION 9. 
9.-Have you reason to believe that leprosy is in any way depen- 
dent ON, OR CONNECTED WITH SYPHILIS, YAWS, OR ANY OTHER 
DISEASE? 
REPLIES. 
CANADA, (New Brunswick.)-It is not connected with syphilis. 
-Dr. J. E. Graham. 
Leprosy is certainly neither dependent on nor connected with 
syphilis. It cannot be dependent on any other malady, it being a 
specific disease, quite distinct, therefore, from all other distempers. 
A leper' may become syphilitic as he may become phthisical, he may 
catch small-pox as he may catch the itch: he may die from any inter- 121 
current ailment, as he may be killed by accident; equally, in such 
and other similar cases, the event is not of leprosy, but in addition 
to it. There never was any trace of syphilitic affection discovered 
in any of the lepers in New Brunswick; small-pox never happened 
among them ; the itch made its appearance in the Lazaretto on few 
occasions.-Dk. J. C. Tache. 
I have no reason to suspect that leprosy in any way depends on, 
or is connected with any other disease;-it is a disease sui generis.- 
Dr. A. C. Smith. 
CANARY ISLANDS.-I do not believe that leprosy has any rela- 
tion with the other affections called syphilitic, scrofulous or erup- 
tive.-Dr. A. Navarro Torrens. 
CEYLON.-I have sometimes found it connected with scrofula, 
syphilis and parang; but have no reason to believe that it is in any 
way dependent on these diseases. Leprosy also occurs associated 
with scabies, eczema, psoriasis and other diseases among the fish- 
eating population of the islands. I have seen it in connexion with 
Elephantiasis Arabum.-Dr. W. R. Kynsey. 
GUATEMALA.-I know of only one leper, who was syphilitic 
before being attacked with leprosy; my other patients have had no 
syphilis. I have observed that a mercurial treatment aggravates the 
disease.-Drs. Valladores and Yela. 
MEXICO.-I do not believe this disease has any connexion with 
syphilis. Anti-syphilitic treatment breaks down.-Dr. J. M. Gomez. 
NETHERLANDS.-It cannot be proved that leprosy is in any cor- 
rellation with such other diseases as syphilis, framboesia, etc.-Dr. 
J. van Deventer. 
NORWAY.-No.-Consul-General. 122 
QUESTION 10. 
10.-Have you met with instances of the disease appearing to be 
CONTAGIOUS, IN THE ORDINARY SENSE OF THAT TERM. i. e., COM- 
MUNICATED TO HEALTHY PERSONS BY DIRECT CONTACT WITH, OR 
CLOSE PROXIMITY TO DISEASED PERSONS? 
A - IF SO, IN WHAT STAGE WAS THE MALADY IN THE DISEASED 
person? Were there ulcerations with a discharge? 
B.-Please to describe briefly the case or cases of conta- 
gious COMMUNICATION WHICH YOU HAVE SEEN YOURSELF. 
C.-Does the disease seem to be transmissible by sexual 
INTERCOURSE? 
REPLIES. 
CANADA, (New Brunswick.)-Have known of cases, but have 
not seen any. 
c. It is communicable by sexual intercourse.-Dr. J. E. Gra- 
ham. 
I am aware of many instances of the disease appearing to be con- 
tagious, in the ordinary sense of that term; I mean instances in 
which heredity cannot be invoked and in which contagion is the only 
cause capable to reasonably account for the propagation of the 
malady. The typical character of leprosy, the category to which it 
consequently belongs in the nosological table, its general history and 
what 1 have ascertained in New Brunswick leave no doubt in my 
mind about the contagiousness of the disease. I firmly believe it is 
communicable from the diseased to the healthy. I do not think, 
from what I have observed, that proximity, no matter how close, nor 
mere touch, can convey the contagion. In my opinion, there must 
be an adequate contact of some kind, mediate or immediate, of 
course, with an individual susceptible of contracting the malady, 
and, at the time, so circumstanced as to be in a situation to receive 
it. I hold contagion as the cause of the propagation of the dis- 
ease ; and in so saying I do not lose sight of the fact of the occa- 
sional spontaneous production of leprosy; importation, of course, 
means contagious spreading into one country, when it extends 
beyond immigrants sick, and their descendants.-Dr. J. C. Tache. 
I have not met with instances of the disease of which I could 
affirm that they had been communicated by diseased persons ; but I 
am convinced that leprosy is contagious, although not to the extent 
of other contagious disease. The people of the leprous district 123 
intermarry very freely, and it is difficult to exclude hereditary taint. 
But I am confident that in former years persons free from heredi- 
tary taint contracted the disease, while living in Tracadie.-Dr. A. 
C. Smith. 
CANARY ISLANDS.-I do not know of any case of contagion of 
leprosy by means of contact, more or less direct,-including sexual 
intercourse.-Dr. A. N. Torrens. 
CEYLON.-It is not considered contagious in Ceylon. It is, in 
my opinion, not contagious as syphilis, parang, or the exanthema- 
tous diseases. There is no conclusive evidence in the hospital 
records of communicability by direct contact with, or close proxi- 
mity to diseased persons. It certainly does not appear to be trans- 
missible by sexual intercourse.-Dr. W. R. Kynsey. 
GUATEMALA.-I have not. I think it is transmissible by 
sexual intercourse.-Drs. Valladores and Yela. 
MEXICO.-There is not a single case of contagion either direct 
or through proximity to the disease. There has been no case of 
transmission of the disease by sexual intercourse.-Dr. J. M. 
Gomez. 
NETHERLANDS.-Not one case of contagion has ever been 
recorded. In some families though both parents are pure Europe- 
ans, and had never been in India before, one of many children was 
seized with leprosy without any assignable cause.-Dr. J. van De- 
venter. 
NETHERLANDS, (Colonies.)-In the East Indies they think 
that leprosy is not contagious, and in the West Indies that it is. 
The natives in the Netherlands Indies are indifferent in regard to 
the disease.-Colonial Minister. 
Leprosy in the only forms in which we see it in the Netherlands is 
not transmitted from one person to another, except as hereditary 
disease.-Dr. Egeling. 
N ORWAY. -No. -Consul-General. 
SIAM.-The prevalent opinion as to the contagiousness of leprosy 
is that the disease is not catching. I have many times seen families 
sitting together, or people crowded in a public gambling or other 
house amongst whom was a leper and no notice was taken of him.- 
Consul Kurtzhalss. 
SPAIN.-Have been unable to observe any case of contagion, 
but it must be taken into account that the malady has not presented 
itself under any other form than the endemic.-The Faculty. Bar- 
celona, 124 
QUESTION 11. 
11.-Are persons affected with Leprosy permitted in * * * * 
TO COMMUNICATE FREELY WITH THE REST OF THE COMMUNITY? OR 
IS THERE ANY RESTRICTION IMPOSED, OR SEGREGATION ENFORCED, 
IN RESPECT TO THEM? 
* REPLIES. 
CANADA, (New Brunswick.)-In Tracadie they are kept in a 
lazaretto, but they have liberty to see their friends.-Dr. J. E. Gra- 
ham. 
Persons affected with leprosy are segregated in New Brunswick, 
and do not communicate freely with the rest of the community when 
the existence of the disease is fully ascertained, and their entry in 
the Lazaretto has been secured; there has been, however, a few 
accidental exceptions to this rule; I do not speak here of the occa- 
sional visits of relatives and friends, which are allowed under cer- 
tain restrictions. 
For years past the segregation has not been enforced by violent 
measures, but the exertions, particularly on the part of the clergy, 
to induce the sick to enter the Lazaretto have been unceasing, and 
the result has been that for many years all lepers, with only two 
exceptions that I know for certain, have resorted to the Lazaretto 
and have remained there till death, or are there yet. The two 
exceptions are of one girl, who a few years ago, went abroad, and of 
one married woman, who, after a very short sojourn in the Laza- 
retto, was taken out by her husband and died at home. It was only 
in 1844 that a lazaretto was established, there were no means before 
to isolate the lepers; for some years after several lepers died out of 
the Lazaretto. 
The difficulties of early removals, apart from the painful sever- 
ance of family ties, apply to cases in which the labor or services 
rendered by the lepers are still of great importance for their families. 
It would be almost a necessary complement to the establishment of 
Lazarettos to provide some little means to lessen such difficulties 
when they do occur.-Dr. J. C. Tache. 
It is not at all times easy to secure prompt removal of affected 
persons to the lazaretto, but once admitted, segregation is complete 
and permanent.-Dr. A. C. Smith. 
CANARY ISLANDS.-The law places no obstacles in the way of 
marriage between lepers; there exists no other obstacle to a union of 125 
such except the repugnance inspired in the minds of the healthy by 
their appearance.-Dr. A. Navarro Torrens. 
CEYLON.-There is no restriction imposed or segregation 
enforced by legislative enactment or otherwise in respect of lepers 
in this colony. A partial restriction is perhaps observed among the 
home-dwellers in villages.-Dr. W. R. Kynsey. 
GUATEMALA.-No: they are strictly segregated. Refers to 
Question 8.-Drs. Valladores and Yela. 
MEXICO.-Those sick from the disease, of both sexes, are 
placed in different wards.-Dr. J. M. Gomez.' 
NETHERLANDS.-At one time, when leprosy was held to be 
infectious, persons afflicted with the disease both in the Netherlands 
and the colonies were isolated either in special institutions or even 
on certain islands dedicated for that purpose. Now-a-days such 
isolation has ceased to exist, no restriction being put upon the 
leper's liberty. Only in cases of lepra mutilans is the patient 
avoided on account of his unsightly appearance. In the Nether- 
lands persons attacked with leprosy are admitted to the common 
hospitals, where they are ranged by the side of other patients.- 
Dr. J. van Deventer. 
Previous to the year 1865 there were in the Netherlands East 
Indies local and provincial regulations enforcing separation for 
lepers. In 1868, however, because it was thought to be proved 
after long experience that leprosy must be considered to be not con- 
tagious, it was determined on part of the Government that there 
was no reason for forcing the lepers to separate themselves in the 
hospitals or dwell in retired places. In the West Indies where the 
disease is considered to be contagious separation is carefully 
enforced. Persons suspected of this disease who go among the 
public are arrested by the police and thereupon examined by a 
special medical committee. If they are found to be infected they 
are sent to the establishment set apart for the purpose. In the 
Colony of Surinam they go a step further by removing infected per- 
sons to the asylum even if they have not gone among the public.- 
Colonial Minister. 
Leprosy has not been the subject of special legislation in the 
Netherlands as there was no reason for it. A long time ago, driven 
through insufficiently grounded fear, some lepers were transported 
from Brombeck to Vreenhuisen and there forcibly segegated.-Dr. 
Egeling. 126 
NORWAY.-Yes. The only restriction is that when lepers are so 
poor, that they want public support, they are obliged to seek it in 
public asylums, and are not supported in their homes in the parishes 
as other poor.-Consul-General. 
SIAM.-The Government of Siam does not enforce segregation 
of lepers, but there exist certain temples here, the priests of which 
specially devote themselves to attending to paupers and lepers by 
supplying them with food and allowing them to camp on the pre- 
mises of the temple.-Consul Kurtzhalss. 
SPAIN.-Communication between lepers and healthy persons is 
not restricted in Spain.-The Faculty. Barcelona. 
QUESTION 12. 
12.-What public provision is made for the reception and treat- 
ment of the Leprous poor? Are they admitted into the 
GENERAL HOSPITALS? OR. ARE THERE SEPARATE INFIRMARIES OR 
ASYLUMS PROVIDED FOR THEM? PLEASE TO DESCRIBE THE STRUC- 
TURAL AND SANITARY CONDITIONS OF SUCH BUILDINGS AND THE 
ARRANGEMENTS MADE FOR THE MEDICAL AND HYGIENIC TREAT- 
MENT OF THE SICK IN THEM. 
REPLIES. 
CANADA, (New Brunswick.)-A separate infirmary is provided 
by the Government.-Dr. J. E. Graham. 
An institution, supported at the public expense, is provided for 
the lepers, where these unfortunates are under the care of Sisters of 
Charity, ministered by a chaplain and visited by a physician. The 
leprous sick are not sent to general hospitals.-Dr. J. C. Tache. 
Dr. A. C. Smith refers to Dr. Tachi's reply. 
CANARY ISLANDS.-In the hospital (Las Palmas de Gran Cana- 
ria) there is no compulsory segregation, but voluntary. It is only 
when the lepers dedicate themselves to medical treatment that the 
authorities compel them to be secluded.-Dr. A. Navarro Torrens. 
CEYLON.-An asylum has been in existence prior to the com- 
mencement of the present century. It is wholly supported by the 
Government at an annual cost to the colony of Rs 15,400.-Dr. W. 
R. Kynsey. 127 
MEXICO.-There was formally a special hospital but now the 
lazars occupy wards in a civil hospital.-Dr. J. M. Gomez. 
NETHERLANDS.-The old leper houses in the Netherlands have 
long been converted into hospitals for chronic diseases, but in the 
pauper (?) colonies of Ommerschaus and Vreenhuisen there is a shed 
or special ward affording accommodation for twelve persons; though 
as a rule not more than six beds are occupied.-Dr. J. van Deven- 
ter. 
(Colonies.)-In the East Indies there yet existed in 1865 
fourteen asylums for lepers, but, in consequence of the 
regulation of that year, eight of them were gradually abolished. 
The six which still exist serve for voluntary asylums for lepers. In 
Surinam there exists one asylum for lepers; in Curacao three. In 
the East India hospitals there were 189 lepers at the end of 1883 
and in the West Indian 144.-Colonial Minister. 
No, unless Vreenhuisen is considered such.-Egeling. 
NORWAY.-There are public asylums where all lepers that seek 
admittance are received free ; in these asylums marriage, of course, is 
prohibited and the two sexes kept apart. Lepers are also admitted 
into general hospitals, but then only when suffering from other dis- 
ease.-Consul-General. 
SIAM.-No royal or private hospitals or asylums for lepers exist 
in Siam as far as my informants and myself are aware of.-Consul 
Kurtzhalss. 
SPAIN.-The hospital, which, in Barcelona, is designed for 
lepers, contains two wards, one for men and the other for women, 
together with accessory departments, and is a branch of the Hospi- 
tal-General of the Holy Cross.-The Faculty. Barcelona. 
QUESTION 13. 
13.-Can you state the number of Leprous persons maintained at 
THE PUBLIC EXPENSE IN ? 
REPLIES. 
CANADA, (New Brunswick.)-About 24 or 25.-Dr. J. E. Gra- 
ham. 128 
The number of inmates in the Lazaretto on the 15th May, 1885, 
was twenty-two, of whom one, a girl, is not a leper; she is afflicted 
with lupus. Of these twenty-one lepers, eleven were men, and ten 
women. The annual grant is $3,200, and includes the small remu- 
neration of the chaplain, the indemnity of the visiting physician, 
the allowance to the sisters and the wages and board of two servants. 
-Dr. J. C. Tache. 
The number at the close of 1884 was twenty-two.-Dr. A. C. 
Smith. 
CANARY ISLANDS.-At the present time there are fifty-four in 
the Las Palmas Hospital, twenty-three males and thirty-one females; 
forty-seven having the tuberculosa form.-Dr. A. Navarro Tor- 
rens. 
CEYLON.-The daily average of lepers in the asylum maintained 
by the Government for the last year was one hundred and twenty- 
five.-Dr. W. R. Kynsey. 
GUATEMALA.-Nine men and six women.-Drs. Valladores 
and Yela. 
MEXICO.-Ordinarily there are thirty patients in the two wards. 
-Dr. J. M. Gomez. 
SPAIN.-From four to ten a year.-The Faculty. Barcelona. 
NORWAY.-In 1880, six hundred and seventeen in Public Asy- 
lums.-Consul-General. 
QUESTION 14. 
14.-Have you reason, from personal knowledge, to believe that 
THE DISEASE HAS BEEN OF LATE YEARS,-SAY DURING THE LAST 15 
OR 20 YEARS.-ON THE INCREASE * * * * OR OTHERWISE? 
And if so. please to state what in your opinion may have 
CONTRIBUTED TO ITS INCREASE OR ITS DIMINUTION. 
REPLIES. 
CANADA, (New Brunswick.)-Somewhat on the decrease.-Dr. 
J. E. Graham. 
Since the establishment of a lazaretto, in 1844, leprosy has been, 
more or less, kept in check in New Brunswick, and for several years 129 
past, especially during the last few years, it has undergone a nota- 
ble diminution. The check and the decrease are in ratio of the 
more or less prompt resort to the lazaretto; segregation is, in my 
opinion, the cause of the diminution of the disease.-Dr. J. C. 
Tache. 
It is on the decrease. At one time there were nearly forty 
inmates of the lazaretto. To the improving condition of the people, 
and the segregation of those affected, I attribute the diminution.-Dr. 
A. C. Smith. 
CANARY ISLANDS.-I believe that the disease is diminishing in 
direct correspondence with the improved condition of the poorer 
classes. -Dr. A. Navarro Torrens. 
CEYLON.-The disease, I have reason to believe, has decidedly 
increased since 1862. I have no doubt that a certain reproduction 
of the disease is going on whatever the factors are at work, and 
that the proportionate growth of leprosy in the colony is by no 
means diminishing.-Dr. W. R. Kynsey. 
GUATEMALA.-The disease has increased in Central America,, 
because the lepers were not, until lately, segregated and members of 
families known to have leprosy were allowed to marry; while it is 
a known fact, that although the son or daughter of a leper may bear 
no visible traces of this disease, the grand children are sure to be 
leprous.-Drs.. Valladores and Yela. 
MEXICO.-This malady has beeen known in Mexico from the 
time of the Conquest, since Herman Cortds founded a hospital 
especially for the lazars. As regards the increase or decrease of 
this disease there has been no noticeable change.-Dr. J. M. Gomez. 
SPAIN.-The disease appears destined to disappear from the peo- 
ple with the advance of civilization and the assiduous cultivation 
and perfecting of the practices of hygiene.-The Faculty. Barce- 
lona. 
NORWAY.-The disease is diminishing yearly. The higher 
civilization, better sanitary habits and the Public Asylums contri- 
bute to the diminution. The known number of lepers was, in 1856, 
2,113; 1860,2,068; 1870, 2,055; and 1880, 1,606.-Consul-Gen- 
eral. 130 
QUESTION 15. 
15. -What results have you observed from the hygienic, the diet- 
etic, OR THE MEDICINAL TREATMENT OF THE DISEASE? DOES 
Leprosy undergo a spontaneous cure? and if so, at what 
STAGE OF THE DISEASE? ARE YOU AWARE WHAT PROPORTION OF 
the Leprous poor treated at the public expense in * * * * 
RECOVER wholly or partially? 
REPLIES. 
CANADA, (New Brunswick.)-No good results from medical 
treatment. Much may be done by attending to the general health 
of patients.-Dr. J. E. Graham. 
The results I have observed from good hygienic and dietetic 
treatment are that the influence of the disease is lessened and life is 
prolonged. This has been rendered very apparent of the Lazaretto, 
especially since the year 1880, that the buildings were made more 
ample and comfortable, other improvements were provided for, and 
the entire management of the dietary was transferred to the care of 
the sisters, from the former direction of a functionary who was 
called keeper-cook. Those beneficial results of good sanitary meas- 
ures are, nevertheless, only a respite of a few years at best. 
The various and multiplied attempts made at different times, in 
New Brunswick, by medical men, or under medical guidance, to 
cure the disease, have all failed, as have also failed several empiric 
methods and vaunted medicines. 
Remedial attendance to common functional disorders, palliative 
treatment of the painful manifestations of leprosy, and attentive 
nursing of the patients, although no cure, are, nevertheless, highly 
beneficial, and are constantly resorted to at the New Brunswick 
Lazaretto. 
I have never seen a spontaneous cure of leprosy; nor has there 
been any, so far, in New Brunswick.-Dr. J. C. Tache. 
As the result of long observation, I am convinced that good hygi- 
enic measures, including a regular system of healthy diet, has great 
power in checking rapid progress in the disease-life is thereby pro- 
longed. 
I have never observed more than a temporary amelioration from 
any medicinal treatment, and only such as might be attributed to 
the influence of the mind over the body. My predecessor used 
colored water-accompanied by strong assurances of benefit there- 131 
from, and in every instance found a temporary improvement, equal 
in degree to any apparent benefit he found from the use of medi- 
cinal agents. I know of no spontaneous cure of the disease, 
although I know instances of temporary abeyance of the disease, last- 
ing, in some cases, during a considerable period.-Dr. J. C. Smith. 
CANARY ISLANDS.-I have not seen any positive and evident 
case of a radical cure by medical treatment. I believe that leprosy 
is incurable (at least in the two forms which I have studied). But 
it sometimes happens that the evolution of the disease is arrested 
leaving the patient for a considerable time in a condition very com- 
patible with health. Without denying that medical treatment can 
materially contribute to this condition I consider that dieting is of 
great efficacy.-Dr. A. N. Torrens. 
CEYLON.-No treatment as yet has been found of any perma- 
nent benefit. The best results have been obtained from hygienic 
and dietetic treatment alone. 
There is at present in the asylum a Malabar patient in general 
good health, admitted with amesthetic leprosy, in whom the disease 
had been fully developed, whose case may be considered as a spon- 
taneous cure; no further symptoms having appeared during the last 
six years, the disease having apparently exhausted itself. I cannot 
confidently assert that any patients have recovered under treatment 
but have been benefitted.-Dr. W. R. Kynsey. 
GUATEMALA.-Lepers should have plenty of fresh air, wear 
flannel clothing, bathe every day in tepid water, eat roast meat, 
thick soups and milk. I have never seen or heard of leprosy under- 
going a spontaneous cure; of my patients in the hospital, two were 
partly cured in the third stage, and one radically in the second 
stage. The two former amesthetic and the latter one tuberculous.- 
Drs. Valladores and Yela. 
MEXICO.-The only favorable results obtained have been an 
alleviation of the sufferings of the sick. Hygienic measures are 
very useful and necessary. Nitrogenuous food and the deprivation 
of all alcoholic beverages have also been found beneficial, and with 
regard to the medicinal treatment, outside of the systematic, I have 
only noted any decided improvement when the sick have been treated 
by the sudorific method. I have never seen a spontaneous cure of 
this malady. During 12 years at this hospital not a single case has 
been restored to health except one who subsequently died.-Dr, J. 
M. Gomez, 132 
NETHERLANDS.-The therapeutic as well as the dipterocarpic 
method of treating the disease have hitherto been ineffectual. In 
the case of a child Dr. Van der Star saw a case of leprosy yield, 
but atrophy of the skin and stenosis set in. On other parts of the 
body the blotches disappeared but atrophy of the skin remained.- 
Dr. J. van Deventer. 
NORWAY.-In 1880, of the 617 lepers in the Public Asylums, 7 
recovered. From 1857 to 1879, 102 are known to have recovered. 
-Consul-General. 
SPAIN.-A great number of medicines have been tried to combat 
this disease but, in almost all cases, without result, except that the 
iodic treatment internally and externally appears to have done some 
good. The patients are afforded a good hygienic and dietetic regi- 
men, allowed to walk around, are kept in perfect cleanliness of body 
and supplied with healthy food and of good quality.-The Faculty. 
Barcelona. 
QUESTION 16. 
1G.-What is the estimated population of ? and when 
WAS THE LAST CENSUS TAKEN? 
IS THERE A GENERAL AND UNIFORM REGISTRATION OF BIRTHS AND 
DEATHS, INCLUDING THE CAUSES OF DEATH? AND IF SO. HOW LONG 
HAS SUCH A REGISTRATION EXISTED? 
REPLIES. 
CANADA, (New Brunswick.)-The population of the whole Pro- 
vince of New Brunswick, according to the last census, was, on the 
4th April, 1881, 321,233 souls. The population of the county of 
Gloucester was 21,014, and the population of the county of 
Northumberland 25,109. There is a uniform registration of births 
and deaths, but it is not general, being only carried on among the 
Catholic population; it does not, however, include the causes of 
death.-Dr. J. C. Tache. 
CEYLON.-February 17th, 1881, the population was 2,759,738. 
There is a uniform registration of births and deaths, including the 
causes of deaths, existing since 1867, kept at the olhce of the Regis- 
trar-General.-Dr. W. R. Kynsey. 133 
GUATEMALA.-Republic, 1,400,000, of which two-thirds are 
full blood Indians. Capital, 60,000 last year. Yes; since eleven 
years ago.-Drs. Valladores and Yela. 
NORWAY.-1,851,438. The last census was taken December 
31st, 1875, for the Provinces; in Christiana every year there is a 
general registration of births and deaths including the causes of 
death. Such a registration has been kept up for centuries.-Con- 
sul-General. 
QUESTION 17. 
17.-Can you state the name of the townships or districts in 
which Leprosy prevails most, and give the number of 
Lepers and the population in each of such townships 
OR DISTRICTS? 
REPLIES. 
CANADA, (New Brunswick.)-Leprosy has made its appearance 
in the town of Chatham, in the parishes of Nelson, of Northesk and 
of Alnwick, in the county of Northumberland, and in the parishes 
of Saumarez, of Inkerman, of Chipagan and of Caraquette, in the 
county of Gloucester. 
Total Lepers, 1885.. 
10 H- 00 rH rH 
1 Lepers Outside, 1885 
• rH • 
Lepers in Lazaretto, 
1885 
00 00 • rH 
Population, 1881.... 
2,819 
1,804 
2,322 
3,837 
* 2,646 
Names of Localities. 
Tracadie 
Pokmouche 
Chipagan 
Caraquette 
Nigaouek 
* This is the total population of Alnwick, of which about 200 are to be 
added to Tracadie, about 500 to other circumscriptions, leaving the balance 
to the ecclesiastical parish of Nigaouek.-Dr. J. C. Tache. 134 
CEYLON.-In the Western Province including Colombo, the 
chief city of the Islands, with a population of 897.329, and the 
Southern Province, including the township of Galle, with a popula- 
tion of 433,520. Leprosy is very infrequent in the hilly districts of 
the central and is but rarely observed in the other Provinces of the 
Island.-Dr. W. R. Kynsey. REPORTS ON LEPROSY. 
Enquiry Made by the Hawaiian Government, 
CANADA, NEW BRUNSWICK. 
ANSWERS TO THE INTERROGATORIES SUBMITTED BY HIS EXCELLENCY THE 
MINISTER OF FOREIGN AFFAIRS OF THE KINGDOM OF HAWAII, 
THROUGH MR. C. ELLIOTT ANDERSON, HAWAIIAN CON- 
SUL-GENERAL IN CANADA. 
Answers of Mr. J. C. Tachd, M. D. & L. D., Titulary Professor 
of the Laval University, Knight of the Legion of Honour, Deputy 
Minister of Agriculture, and of Dr. A. C. Smith, M. D. & C. M., 
Member of the Medical Council of New Brunswick, Visiting Physi- 
cian of the Tracadie Lazaretto. 
Ottawa, June, 1885. 
Mr. Tachi's answers:- 
A. 1.-Leprosy is known in the two counties of|Gloucester and of 
Northumberland, in the north-eastern part of the Province of New 
Brunswick, in Canada; that section of the country borders the Baie 
des Chaleurs, the Gulf of St. Lawrence and the lower portion of the 
Biver Miramichi. 
Elephantiasis grcecorum presents itself in New Brunswick precisely 
as it does everywhere else, as a chronic disease of a specific charac- 
ter. It is manifested externally by insensibility, maculae and vari- 
ous extensive colourations of the skin, pemphigus, atrophy, alo- 
pecia (not generalised), ulcers and ulcerations, small tumours 
(tubercules), adenic troubles, pyretic accesses, loss of extremities 
and other disorders, some of which are peculiar to the disease, and 
some simply concomitant lesions of more or less frequent occurrence 
in the course of the malady, the whole ending by suffocation, syn- 
cope, coma, marasmus or cachexia. 136 
a. I have observed, in New Brunswick, what is meant by the 
words "tubercular leprosy" and " anaesthetic leprosy," of many 
authors, or by the words "phymatod leprosy " and "aphymatod 
leprosy," of other writers. What I have to say on this question 
applies also to other distinctions, made by not a few, under the vari- 
ous titles of "macular leprosy," lepra, mutilans, "mixed leprosy," 
&c. All these classifications are based on the presence, absence or 
more or less conspicuous appearance of certain symptoms. 
b. These so-called forms, in my opinion, are the result of one 
common morbid state. 
Amesthesia is invariably present, to a greater or lesser degree, in 
some part of the body, in all cases of leprosy; it is therefore diffi- 
cult to understand how it can be made to characterise any particular 
form. It was from the consideration of the uniform presence of the 
analgesic state in some portion of the accessible surface of the body 
of the leper that the College of Physicians of London, in their 
report on leprosy, proposed to substitute the term " non-tuberculate " 
for the term " anaesthetic." 
Tubercules are oftentimes absent; but inasmuch as those small 
tumours are only one of the manifestations of a process which 
affects, not simply the skin, but also the nerve structures and other 
tissues, the absence or presence of these papules, at a given moment 
or at any time, seems hardly sufficient to warrant an addition to the 
nomenclature. All this, however, is said without losing sight of 
the great importance of that symptom. 
My answer to the second part of question b is easily surmised, 
from what I have already expressed. That which does not consti- 
tute, in my opinion, different forms of the distemper, cannot be for 
me, "specifically distinct diseases, having no affinity with each 
other." Leprosy, to my mind, is one indivisible morbid entity, so 
to speak, although, as in other ailments, its outward manifestations 
are not all produced in every case, and never to be all met together 
at a given moment, in the same individual. It is not, moreover, 
amesthesia, macuhe pemphigus, tubercules, destruction of substance, 
which constitute per se the essence of leprosy: these trophic lesions 
are seen in other diseases ; they succeed traumatism of the nerves; 
they are produced on animals by nervous irritation. What charac- 
terises the disease is the specific labour which produces them, in the 
particular way they present themselves in this affection-to the 
medical observer in shape, colour, odour, mode of evolution-to the 137 
medical philosopher in analogies, differences, causes, effects logic- 
ally deduced from evidence and history. 
c. I have already given the more obvious characters of leprosy 
which I have seen; but I do not take any of them as distinguishing 
different forms of the disease. Most of the outward symptoms of 
leprosy are apt to be absent, to appear, disappear and reappear, suc- 
ceeding and, as it were, supplanting each other, under the operation 
of one specific irritative force, during the long course of the sick- 
ness. I opine, with all due deference for the opinions of others, 
that such a succession and change of phenomena, all due to the same 
exciting agency, constitute a morbid unity, and cannot establish a 
basis upon which these forms can be built. To burden the study of 
the disease with such distinctions and names, is, I humbly but firmly 
hold, complicating matters, without any adequate compensation, 
especially when attempts are made to carry these distinctions so far 
as to separately describe the progress of the disease throughout. 
A. 2.-The disease generally manifests itself after puberty, in 
grown-up adults and middle-aged individuals ; but it comes at almost 
all ages: early infancy, however, seems to be entirely exempt from 
the malady. Children are not frequently attacked by leprosy, and 
it is rarely observed to begin in old age. 
The incipient symptoms are-general uneasiness, drowsiness, irre- 
pressible instinctive anxiety, undefined and not very severe pains, 
followed by hypenemia, hypermsthesia, insensibility, maculae, pem- 
phigus, atrophic manifestations and alopecia, especially of the eye- 
brows. 
A. 3.-The period of life at which the disease attains its full 
development and at which it proves fatal, depends on the period at 
which it has made its first appearance, combined with the length of 
the sickness. The progress and duration of the malady vary very 
considerably: in some cases it destroys its victims in a few years, in 
other cases it lasts many years, and in few' cases a long period of 
time. I have not yet sufficiently worked the problem to attempt to 
give an average, inasmuch as many considerations are to be had in 
the discrimination of the facts from which it would be logical to 
strike a fair mean. 
Women seem to be possessed of a greater powrer of resistance to 
the disease than men. Nine to twelve years are not an uncommon 
duration in both sexes. There are instances of such a slow' progress 
and of such an attenuated malignity of the ailment that life, and 138 
even general fair health, are enjoyed for many years. There are 
now living, in the Lazaretto of New Brunswick, two women who 
have had leprosy with a constant show, although at times somewhat 
obscure, of the characteristic symptoms, for the respective periods 
of at least forty-six and thirty years. In these two cases there are 
yet no signs observed of a profoundly impaired health, far less of a 
near destruction. A woman died a few days ago who had had the 
disease for twenty-two years. 
The development of leprosy can hardly be subjected to a regular 
exposition of stages, so capricious is it in its manifestations and 
duration; many of its symptoms are susceptible of complete disap- 
pearance and reappearance, as already stated. The ailment may be 
said to be in full development when some of its pathognomonic 
symptoms, and the process by which they are produced, are clearly 
discernable. I am led to believe that the time of invasion is to be 
counted by months, during which, and a long time after, the patient 
may ignore, or, knowing, may conceal his situation, if he chooses to 
do so. As there are no sure rules to indicate the phases of the dis- 
ease, this obscurity, and the circumstances of the benignity of the 
first symptoms and of the persistency of the incipient trouble 
through the whole course of the sickness, have induced to assign an 
excessive length for the stage of invasion, that is, for that period of 
langour which is premonitory to the outward signs of the disease. 
Leprosy, however, may be said, grosso modo, to present three 
periods subsequent to the prodromic phases: 1st, the progressive 
period; 2nd, the sickly period; 3rd, the destructive period. The 
first may last a very long time, and may include series of pretty 
severe manifestations ; the second may indure for months or years, 
and offer frequent intermissions of accesses and comparative repose; 
the third is of comparatively short duration, which may, neverthe- 
less, mean more than a year. 
This division, which I venture, and the names 1 give to its periods 
are suggested to me by the character of the disease, its degrees 
being, in reality, susceptible of distinction only when measured by 
the general results on the whole system. 
A. 4.-Leprosy is more frequent in men than in women. The 
proportion is not constant; it varies considerably from time to time, 
and, evidently, from place to place; but there can be no doubt that 
the greater prevalence of leprosy among men than among women is 
one of the features of the disease. 139 
A. 5.-It is historically proved that the disease attacks all races. 
In New Brunswick there have been lepers of French, Scotch, English 
and Irish descent, and lepers of mixed origin. I have had no occa- 
sion to personally observe the existence of the malady in other 
races, as there are none, or hardly any, of other blood in the counties 
of Gloucester and Northumberland than the four mentioned, except 
Indians. The frequency of the disease does not, in my opinion, 
depend on race, but is proportionate to the exposure of the people 
to the causality of propagation. 
By far the greatest number of lepers in New Brunswick is counted 
among the French and the people of mixed origin, and for many 
years past the malady was and is exclusively limited to these two 
catagories. The disease has become endemic only in five localities, 
namely: Tracadie, Nigaouek, Pokmouche, Chipagan and Cara- 
quette, in which the French population is to all other origins as nine 
is to one. There never was any case of leprosy among the Indians, 
although one of their principal villages is located in the endemic 
section, being contiguous to the parish of Nigaouek. 
A. 6.-The disease, in New Brunswick, has occurred among the 
ordinary working classes of varied means, none of the families in 
which it has been met being in affluence and none in misery, all 
being provided with the necessaries of life. The circumstances 
which favour the development of leprosy, in individuals and in 
groups of individuals, are the close intimacy of family life and the 
great sociability of the people. 
a. The places where the malady has occurred are rural, with one 
exception ; all these places are upon the sea-coast or in close proxi- 
mity to it. The interior of the counties of Gloucester and North- 
umberland is not settled. The country is undulating, generally dry, 
well-drained, well-provided with good water and not at all malarial. 
b. The sanitary conditions of the dwellings vary, and do not 
differ in their variety from those of the neighbouring parishes, 
counties and provinces similarly situated. The dwellings of many 
of the affected families are good and well-disposed, others are not. 
The conditions of the immediate vicinity of the houses are very 
good as a rule. 
c. The habits of life are those generally met with among people 
of the same class and following the same occupations. The domes- 
tic and personal cleanliness vary; some are clean and some are not. 
d. The diet has always been good and abundant. The way of 140 
living, so far as it affects the moral and the physic of people, is 
better described by the results than by fanciful or prejudiced des- 
criptions ; the population is well-behaved, intelligent, laborious, 
remarkably healthy, robust and long-lived ; they are not subject to 
any widely prevalent disease of any kind. The natural increase of 
population, among these people, is exceptionally great. 
e. The ordinary occupations, are farming, by far the most impor- 
tant, fishing and lumbering, and a mixture of them. All lepers 
have been from families connected with these occupations except one 
merchant, one the daughter of a miller and a few who belonged to 
the class of artisans. 
Several families were and are reduced, some very much, in cir- 
cumstances, on account of the existence of leprosy in their midst; 
the malady was or is the cause of the poverty, not the poverty of 
the malady. 
I have said before that the Indians have been the only race, of 
those inhabiting these localities in any number, which have remained, 
so far, exempt from leprosy; it is well, then, to recite the conditions 
of their existence as connected with the purport of the question I 
am now answering. The places in which the Indians dwell bear 
precisely the same character as those inhabited by their neighbours, 
among whom the ailment has exercised its ravages. The occupa- 
tions of these aborigines are farming, on a very small scale indeed, 
fishing, hunting, lumbering and cognate industries; these people are 
provided with the necessaries of life; they are well-behaved, intelli- 
gent and commonly healthy, although not generally long-lived; they 
are much more subject to scrofula and consumption than all the 
other races, and have no great power of resistance to sickness, as a 
rule; they do not increase in number; their dwellings, with few 
exceptions, are very poor, much inferior, save such exceptions, to 
the very worst houses of the white population. In one word, their 
circumstances are, at best, equal, and generally inferior to those of 
the poorer whites. The only reason I can see for the complete 
immunity they have enjoyed is that, although friendly with the other 
races, they do not socially come in close intercourse or contact with 
them. Every race, as a rule, keeps the closest company with their 
own blood, and the most intimate social relations are seen with the 
French amongst themselves. 
A. 7.-There are no conditions nor circumstances of life that 
seem to accelerate or aggravate per se the disease, beyond what 141 
applies to all ailments. Everything calculated to depress the moral 
or physical forces renders the individual sick less able to resist the 
ravages of this malady and, therefore, quickens its development 
and its fatal termination; but the idea that the eating of a particular 
article of food, the use or non-usage of certain articles of habili- 
ment, can influence the production and spread of leprosy, is, in my 
humble opinion, quite inadmissible. There are no more reasons, that 
I see, to attribute the disease to, or to connect it with, climate, 
dwellings, food or habits of life, than there is as regards small-pox, 
syphilis, measles and other universal distempers, specific in their 
character; of course crowding, and all which favours close contact, 
necessarily multiply the risks of contagion and infection for all 
specific diseases, as well as isolation is a preventive against the 
spread of such ailments. I cannot take up here the question of 
common (not banal) causes possibly being factors in the spontane- 
ous elaboration of viruses, nor can I here enter into the study of 
the theory of micro-organisms in connection with specific diseases. 
A. 8.-The disease does not appear to me to be hereditary, that 
is transmitted, de toutes pieces, from parents to offspring by pro- 
creation, or stored in the blood of individuals or generations, in its 
morbid nature and potential energy, without show of its presence. 
I doubt not, however, that the greater or lesser susceptibility to 
contract or acquire the distemper forms part of constitutional inheri- 
tance. Families may have received from parents and ancestors 
innate organic peculiarities, which render their members, or some, 
or many of them, not necessarily, but eventually, easier preys to 
the disease, when the exciting cause is brought, with effective force, 
to act upon them. 
I know many instances where one member only of a family has 
been affected with leprosy, while all the other members remained 
free from any trace of it. In this connection, it is not idle talk to 
remark that the mere fact of the appearance of several cases of a 
disease in one family is, prima facie, no more suggestive of heredi- 
tary than of contagious transmission. The significance of the occur- 
rence is a matter of medical and philosophical criticism, which has 
to consider the character of the malady, the order of time, and the 
circumstances and surroundings of each case. 
A. 9.-Leprosy is certainly neither dependent on nor connected 
with syphilis. It cannot be dependent on any other malady, it being 
a specific disease, quite distinct, therefore, from all other distempers. 142 
A leper may become syphilitic as he may become phthisical; he may 
catch small-pox as he may catch the itch ; he may die from any inter- 
current ailment, as he may be killed by accident; equally, in such 
and other similar cases, the event is not of leprosy, but in addition 
to it. There never was any trace of syphilitic affection discovered 
in any of the lepers in New Brunswick ; small-pox never happened 
among them; the itch made its appearance in the Lazaretto on few 
occasions. Only two lepers are known to have died from intercur- 
rent diseases: one, a girl, from phthisis; the other, a man, from 
pleurisy. Of course, the invasion of an accompanying chronic ail- 
ment may be anterior or posterior to the development of leprosy in 
the individual. In the case alluded to, of the phthisical girl, phthi- 
sis showed itself in the course of leprosy, and exercised over the 
latter affection a decided revulsive and depurative action. 
A. 10.-I am aware of many instances of the disease appearing 
to be contagious, in the ordinary sense of that term ; I mean instances 
in which heredity cannot be invoked and in which contagion is the 
only cause capable to reasonably account for the propagation of the 
malady. The typical character of leprosy, the category to which it 
consequently belongs in the nosological table, its general history and 
what I have ascertained in New Brunswick leave no doubt in my 
mind about the contagiousness of the disease. I firmly believe that 
it is communicable from the diseased to the healthy. I do not think, 
from what 1 have observed, that proximity, no matter how close, nor 
mere touch, can convey the contagion. In my opinion, there must 
be an adequate contact of some kind, mediate or immediate, of 
course, with an individual susceptible of contracting the malady, 
and, at the time, so circumstanced as to be in a situation to receive 
it. I hold contagion as the cause of the propagation of the disease: 
and in so saying I do not lose sight of the fact of the occasional 
spontaneous production of leprosy; importation, of course, means 
contagious spreading into one country, when it extends beyond 
immigrants sick, and their descendants. 
There is a case, the facts of which are established beyond possi- 
bility of cavil, in which the disease appears to me, as well as it did 
to those who witnessed it, to h,ave been produced by the absorption 
of liquid matter discharged from the body of a woman who had 
died in a cachectic state from leprosy. At the funeral of that 
woman the body was carried (according to a then long-standing cus- 
tom, which has been since abandoned on account of what, I am now 143 
reciting) on the shoulders of four strong young men. The day was 
hot, and, on a sudden, liquid matter began to oose out through a 
joint of the coffin, wetting the shoulder of one of the carriers. The 
wet, combined with the heat and the pressure of the sharp edge of 
the coffin, produced an abrasion of the skin of the young man. The 
contact of the liquid matter with the abraded surface lasted a part of 
the time of the procession and the whole length of the service, as it 
was only on his return home that the young man washed his sore 
shoulder and changed his clothing. Some months after, that man, 
whose health had always been robust, began to feel unwell; in a 
short time the symptoms of leprosy made their appearance, and he 
died of the disease eleven years after the occurrence. There had 
never been any case of leprosy in his family, whose ancestral gene- 
alogy is traced for several generations back; in fact, the disease was 
not yet known as leprosy, being of recent appearance in the locality 
and among these people ; he was the fourth case in that place, the 
three others being the woman spoken of, the husband and the sister 
of the woman, in the ancestry of whom there had never been, 
neither, any trace of the disease; the fifth case in that locality was 
the sister of that young man. The woman's husband and sister had 
the disease a few years before her death, and the young man's sister 
a few years after the commencement of the disease in her brother. 
a. The woman spoken of had ulcerations, with abundant dis- 
charge, at the time of her death. This would be a case of the 
well-known survivance or posthumous persistency of the malignity 
of virulent matter. 
b. I have not seen, myself, any case of contagious communication, 
if by that is meant the eye-witnessing of the application of the conta- 
gium, whatever that may be, followed by the development of the dis- 
ease. I have never tried to inoculate or otherwise produce leprosy. 
The contagious character of a disease, especially when the disease is of 
slow development and of great lastingness, can be and must be 
proved, according to my ideas, by the study of the intimate nature 
of the ailment, of its appearance, spread and disappearance, within 
certain areas and in relation to groups of population. It is the 
principle of circumstancial evidence applied to etiology, a kind of 
evidence which, in such matters, I, for one, consider much surer 
than the testimony of few or several witnesses, who possibly may 
delude themselves or be deluded. The negative proofs are of some 
value only when general in character, and, at the same time, not 144 
contradicted by positive facts. This negative evidence has been 
invoked in the case of the most evidently contagious diseases. 
The way in which leprosy disappeared from countries where it 
formerly prevailed, the common consensus of nations, as proved by 
their legislation and the means taken by Church and State to eradi- 
cate the disease, are witnesses to the contagiousness of leprosy; 
what 1 have ascertained and observed myself, in New Brunswick, is 
in full confirmation of the truth of that belief. It cannot be expected 
to have such a subject treated in the short answers to an interroga- 
tory. I intend to do so in a work, the materials of which I have 
been collecting for many years, if I am spared to complete my 
investigations and to finish the labour now far advanced. 
c. One husband of a leprous woman and one wife of a leprous 
husband have, so far, had the disease in New Brunswick. The 
sexual organs, in both sexes, are apt to show several of the mani- 
festions of leprosy; the logical inference is, that if the malady can 
be communicated by contact or inoculation, such a contact as is pro- 
duced in sexual intercourse, may give effect to the transmissibility 
of the affection; provided the local lesions of the diseased are such 
as to produce the transmission, and the healthy subject is suscep- 
tible of acquiring the malady. 
It is proper to remark here that there never was, in New Bruns- 
wick, a marriage contracted by a leper, man or woman; but married 
people have continued to cohabit after the appearance of the disease 
in one of the conjoints. The details which would be necessary to 
judge of the extent of the exposure have not been, and could hardly 
be investigated, except in two cases in which, I believe myself suffi- 
ciently informed of the fact, there were no apparent local lesions. 
In these two cases the same conjoints did not get leprosy, and the 
children born from that cohabitation are not lepers. 
A. 11.-Persons affected with leprosy are segregated, in New 
Brunswick, and do not communicate freely with the rest of the com- 
munity when the existence of the disease is fully ascertained, and 
their entry in the Lazaretto has been secured; there has been, how- 
ever, a few accidental exceptions to this rule; I do not speak here 
of the occasional visits of relatives and friends, which are allowed 
under certain restrictions. • 
For years past the segregation has not been enforced by violent 
measures, but the exertions, particularly on the part of the clergy, 
to induce the sick to enter the Lazaretto have been unceasing, and 145 
the result has been that for many years all lepers, with only two 
exceptions that I know for certain, have resorted to the Lazaretto 
and have remained there till death, or are there yet. The two 
exceptions are of one girl, who, a few years ago, went abroad, and 
of one married woman, who, after a very short sojourn in the Laza- 
retto, was taken out by her husband and died at home. It was only 
in 1844 that a Lazaretto was established, there were no means before 
to isolate the lepers; for some years after several lepers died out of 
the Lazaretto. 
The difficulties of early removals, apart from the painful sever- 
ance of family ties, apply to cases in which the labour- or services 
rendered by the lepers are still of great importance to their families. 
It would be almost a necessary complement to the establishment of 
Lazarettoes to provide some little means to lessen such difficulties 
when they do occur. 
A. 12.-An institution, supported at the public expense, is pro- 
vided for the lepers, where these unfortunates are under the care of 
Sisters of Charity, ministered by a chaplain and visited by a physi- 
cian. The leprous sick are not sent to general hospitals. 
The building devoted to lepers, located in the parish of Tracadie, 
officially called Saumarez, in the county of Gloucester, occupies a 
pretty situation; it is a wooden structure, comprising three divisions, 
one for the sisters, one for the male and another for the female 
patients; each division is again sub-divided in wards and rooms. 
There is a small inside chapel. 
The sanitary conditions are, we may say, good. There have been 
very few cases of complication of the disease with other serious ail- 
ments ; of course, I do not take symptomatic diarrhoea and other 
symptomatic catarrhal affections as distinct intercurrent diseases. 
The establishment is provided with a pharmacy, baths and other 
minor contrivances. The whole is on a very modest scale indeed, 
but has answered the purpose. It is much better now than it 
formerly was. 
The attendance and nursing are all that could be desired, such as 
religious motives can inspire and charitable commiseration can 
bestow. Notwithstanding the economy of the annual grant, the 
inmates of the Lazaretto are made as happy as they can be under 
the direful visitation to which they are submitted, and to which they 
do submit with admirable resignation: truly, they obey the precept 
given by the church, to their brethren of the middle-age-/Sis mortu- 
us mundo iterum Deo vivens. 146 
A. 13.-The number of inmates in the Lazaretto on the 15th 
May, 1885, was twenty-two, of whom one, a girl, is not a leper; 
she is affected with lupus. Of the twenty-one lepers eleven were 
men and ten women. The annual grant is $3,200, and includes the 
small remuneration of the chaplain, the indemnity of the visiting 
physician, the allowance to the sisters and the wages and board of 
two servants. 
A. 14.-Since the establishment of a Lazaretto, in 1844, leprosy 
has been, more or less, kept in check, in New Brunswick, and for 
several years past, especially during the last few years, it has under- 
gone a notable diminution. The check and the decrease are in ratio 
of the more or less prompt resort to the Lazaretto; segregation is, 
in my opinion, the cause of the diminution of the disease. 
The population of the Lazaretto has undergone oscillations of 
numbers from a larger to a smaller figure and vice versa, on account 
of the variations in the annual number of deaths and on account of 
the success of the exertions to bring in all known cases of the dis- 
ease : therefore it would not do to rely on the number of inmates of 
the Lazaretto, at a given moment, to judge of the comparative pre- 
valence of the malady, from year to year; the outdoor lepers must 
be counted as well as the indoor patients. 
The diminution in the number of persons affected by the disease, 
in New7 Brunswick, has been slow but steady for a good many years. 
1 repeat, this is entirely due to stricter outer precautionary measures 
and to effective insulation. The absolute number of lepers is 
reduced, and the diminution in ratio of the population is still greater. 
I give here two tables, showing the absolute numbers and the entire 
movement of the leper population, in New Brunswick, for the last 
decenniad. Uemarks.-The figures marked a, in Table I., column 5, referred to a young boy sent to the Lazaretto on suspicion of 
leprosy, lie was not a leper, and was, consequently, discharged in 1876, The figures marked 5, in Table L, column 
6, concern a young girl affected with lupus; she has been allowed to remain under the care of the sisters. The figure 
marked c, in Table II., column 9, relates to a married woman who died at her own house, and whose disappearance 
influences tee result of the leper population at large, but not that of the Lazaretto. 
1 875-1HH5. 
Years. 
Patients in 
the 
Lazaret. 
Total 
Patients 
in the 
Lazaret. 
Not 
Leprous in 
theLazaret 
Total not 
Leprous 
in the 
Lazaret. 
Lepers in 
the 
Lazaret. 
Total in 
the 
Lazaret. 
Lepers 
Outside. 
Total 
Lepers 
Outside. 
Lepers in 
New 
Brunswick. 
Total 
Lepers in 
New 
Br' nswiek 
M. 
w. 
M. 
W. 
M. 
w. 
M. 
W. 
M. 
W. 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
1875 
15 
6 
21 
Id 
Ct 
14 
19 
6 
11 
17 
20 
16 
1876 
14 
8 
1« 
Id 
2 
13 
7 
20 
6 
10 
16 
19 
17 
36 
1877 
10 
6 
16 
Id 
1 
10 
n 
15 
7 
12 
19 
17 
17 
34 
1878 
6 
9 
15 
Id 
1 
6 
8 
14 
7 
9 
16 
13 
17 
30 
1879 
9 
9 
18 
Id 
1 
9 
3 
17 
7 
12 
14 
15 
29 
1880 
8 
8 
16 
Id 
1 
8 
7 
15 
4 
8 
12 
12 
15 
27 
1881 
6 
10 
16 
Id 
1 
6 
9 
15 
5 
8 
13 
11 
17 
28 
1882 
8 
14 
22 
Id 
1 
8 
13 
21 
o 
3 
8 
13 
16 
29 
1883 
11 
15 
26 
Id 
1 
11 
14 
25 
4 
1 
15 
15 
30 
1884 
10 
13 
23 
Id 
1 
10 
12 
22 
4 
1 
5 
14 
13 
27 
1885 
10 
12 
22 
Id 
1 
10 
11 
21 
3 
1 
4 
13 
12 
25 
TABLE I.-Statement or the number of patients in the Lazaretto, Lepers and not Lepers, the number of 
Lepers outside of the Lazaretto, and the total number of Lepers in the Province of New Brunswick 
on the 1st January of each year mentioned. TABLE II.-Movements oe the population of the Lazaretto of Tracadie, and of the whole Leprous population' 
of New Brunswick, during each year of the last decenniad, with number remaining on the 31st December 
OF EACH YEAR. 
Years. 
1 
]875.; 
Entered in 
the 
Lazaret. 
Total 
Entrd 
4 
3 
Deaths in 
the 
Lazaret. 
Total 
Deaths in 
the 
Lazaret. 
7 ■ 
2 
7 
4 
Deaths 
Outside. 
Grand 
Total 
of 
Death 
10 
2 
5 
7 
New Cases 
Total 
New 
Cases. 
18 
2 
3 
3 
4 
3 
3 
2 
2 
Lepers in 
the 
Lazaret. 
Total 
Lepers in 
the 
Lazaret, 
Dee. 31. 
16 
20 
15 
14 
17 
15 
15 
21 
25 
22 
21 
Lepers 
Outside, 
Dec. 31. 
Grand 
Total 
Lep'rs 
19 
3G 
34 
30 
29 
27 
28 
29 
30 
27 
25 
M. 
2 
1 
W. 
8 
2 
M. 
5 
2 
3 
6 
1 
3 
2 
w. 
6 
M. 
8 
w. 
9 
M. 
11 
1 
1 
2 
2 
1 
1 
2 
2 
W. 
12 
1 
2 
1 
2 
2 
2 
M. 
14 
13 
10 
6 
9 
8 
6 
8 
11 
10 
10 
w. 
15 
7 
8 
8 
7 
9 
13 
14 
12 
11 
M. 
17 
6 
7 
7 
5 
4 
5 
4 
4 
3 
W. 
18 
10 
12 
9 
7 
8 
8 
3 
1 
1 
1 
1876 
2 
1 
3 
2 
1877 
2 
4 
4 
3 
1 
2 
5 
2 
6 
7 
3 
2 
7 
5 
1878 
1c 
1879 
2 
1880 
2 
1 
1 
3 
2 
32 
2 
1 
1 
3 
9 
33 
1881 
2 
3 
1 
1 
2 
1 
13 
1882 
1 
1 
1» 
1883 
1884 
1 
15 
1 
34 
19 
- 
1c 
12 
10 
22 
1885 
1 
1 
1 
1 
1 
11 
10 
21 
2 
1 
24 
Movements between the 1st of January and the 15th of May. 1885. 149 
It is not useless to repeat that the history of Lazarettoes alone is 
not a complete history of leprosy in the countries where these hospi- 
tals are established, and that the history of cases, as inmates of such 
hospitals, is not a full history of those cases, and it is for this rea- 
son that the preceding tables are made to take in the lepers at large 
as well as the lepers inhabiting the Lazaretto. 
The figures of columns 11, 12 and 13, in Table II., may be some- 
what defective, not in total numbers, but in the distribution of cases 
as appertaining to each particular year, on account of the extreme 
difficulty to ascertain with some precision the exact time of the 
beginning of the disease. They may also be deficient in so far as 
there might possibly exist one or two cases of leprosy not yet 
detected. But such little defects, if there are such defects, cannot 
materially influence the grand results, nor can they at all alter the 
significance of these tables: the broad facts would remain, with their 
distinctive features, in spite of the greatest possible deficiency of 
some details. 
No leper, in New Brunswick, ever entered the Lazaretto on the 
first year of the outbreak of the disease; very few, if any, on the 
second year of the existence of the malady; several on the third 
year; many on the fourth, several on the fifth, and some at a still 
more advanced period. The patient hereinbefore mentioned, who 
has now been at least forty-six years a leper, expended only nine 
years of that time in that institution, on two distant occasions; she 
had been about six years sick when the Lazaretto was established. 
The two tables concern altogether 58 patients, 32 men and 2G 
women; of these 58 cases, 36 are anterior to the first of January, 
1875, and 22 are posterior to that date. The tables show that the 
disease has undergone, on the whole, a considerable diminution; not- 
withstanding the fact that the mortality has been, comparatively as 
well as absolutely, much less during the last five years of the decen- 
niad. Another gratifying fact revealed by these tables, a fact which 
I consider connected with the decrease of the malady in the relation 
of cause and effect, is that a much greater proportion of the leper 
population existing at a given moment has been, for some years past, 
segregated in the.Lazaretto than was formerly the case. 
A. 15.-The results I have observed from good hygienic and 
dietetic treatment are that the influence of the disease is lessened 
and life is prolonged. This has been rendered very apparent at the 
Lazaretto, especially since the year 1880, when the buildings were 150 
made more ample and comfortable, other improvements were pro- 
vided for, and the entire management of the dietary was transferred 
to the care of the sisters, from the former direction of a functionary 
who was called keeper-cook. These beneficial results of good sani- 
tary measures are, nevertheless, only a respite of a few years at 
best. 
The various and multiplied attempts made at different times, in 
New Brunswick, by medical men, or under medical guidance, to 
cure the disease, have all failed, as have also failed several empiric 
methods and vaunted medicines. 
Remedial attendance to common functional disorders, palliative 
treatment of the painful manifestations of leprosy, and attentive 
nursing of the patients, although no cure, are, nevertheless, highly 
beneficial, and are constantly resorted to at the New Brunswick 
Lazaretto. 
I have never seen a spontaneous cure of leprosy; nor has there 
been any, so far, in New Brunswick, where all lepers have died of 
the disease who are not still alive, with the exception of one death 
from intercurrent phthisis and one from intercurrent pleurisy. There 
have been discharges, especially of children, from the Lazaretto, of 
several who had been received on mere suspicion or unconfirmed 
diagnosis, and many years ago of a few lepers who were reported 
cured, but who have all come back with the disease. One of these, 
now in the Lazaretto, is the woman I have before mentioned as 
having had the disease for at least forty-six years. This case is so 
very remarkable in many respects that I think it well to recite it. 
This woman was born in 1813, and was married in 1832. She was 
strong and healthy, and the mother of two children, when the dis- 
ease made its first appearance in her system-about 1838. She 
nevertheless continued to cohabit with her husband, to attend to her 
household, to enjoy fair health, and had three children after the 
outbreak of the disease; the last of these, the fifth, so far, was at 
the breast, nursed by the mother, when both were forced to enter 
the Lazaretto, on its opening in 1844. During her sojourn in this 
institution her general health was good, but the malady made local 
progress, at first fearfully mutilating her hands and feet. Then she 
entered a period of quasi suspense, during which, after having been 
submitted to a medical treatment, she was declared cured, and dis- 
charged in 1849. Being returned to her husband she got a child in 
1850, and another, the seventh, in 1854. She lived at home with 151 
her husband, who died in 1874, and then witli her son till 1880. 
Then she entered the Lazaretto for the second time. During the 
thirty-one years that elapsed between her exit from and her return 
to the Lazaretto, she was an enigma for all her relations and neigh- 
bours; some said she was cured, some said she was not; at times she 
appeared well, at other times she did not look so well. I visited her 
at home on several distant occasions, and this is what I have been 
able to observe and gather:-A very slow, but still apparent, pro- 
gress of the morbid process in the appendages of her eyes; pains in 
the bones, which she attributed to rheumatism. 1 succeeded in 
getting, in spite of her unwillingness to account for herself, some 
information of the presence of amesthesia fixed in her mutilated 
hands and feet, and undergoing changes of localisation in other 
parts of her body; these must have been followed by other occa- 
sional outward manifestations; she would not, however, admit any 
such thing. I felt sure that the malady was still in her, and told the 
Sisters that, if she did not die from some other cause before, she 
was sure to come again in the Lazaretto, where she is now, yet 
strong enough for her seventy-two years of age, but with character- 
istic amesthesia, bone-aching and the occasional development of 
small leprous ulcers. 
The husband was, to his last days* perfectly free from any sign of 
leprosy. Of her children, grandchildren and great grandchildren, 
only one has been the victim of the malady-her last child, a girl, 
who died a few days ago at the Lazaretto. That girl was attacked 
by the disease in 1863, in her ninth year of age, and is the patient 
I have mentioned in whom the ailment has lasted twenty-two years. 
The father and mother of the old woman, as well as her ancestors, 
were all free from the disease to their deaths; but a sister-in-law, 
with whom she was in intimate relation, died of leprosy; and two of 
her younger brothers, also, fell victims of the malady. 
The case of that woman proves that leprosy may attack a person 
free from any hereditary taint; it proves that fecundity of women 
can be preserved even when the malady had lasted for a long time, 
although it is not so in every case; it proves that cohabitation may 
not. communicate the disease, although it may in certain cases; it 
proves that children are born healthy, notwithstanding the existence 
of leprosy in parents, although they may acquire it. As regards the 
question of hereditary and contagious transmission, this remarkable 
case offers an interesting subject of study, which I intend to take 
up, with several other cases, in my projected work on leprosy. 152 
A. 16.-The population of the whole Province of New Brunswick, 
according to the last census, was, on the 4th of April, 1881, 321,- 
233 souls. The population of the county of Gloucester was 21,614 
and the population of the county of Northumberland 25,109. 
The total area of New Brunswick covers 17,393,410 acres of land. 
The superficies of the county of Gloucester amount to 1,077,960 
acres, and the area of the county of Northumberland is 3,046,640 
acres, as approximately ascertained by geographical measurements 
made in connection with the census. 
The superficies occupied, that is comprised in the inhabitants' 
holdings, amounted to 189,346 acres in the county of Gloucester and 
to 265,148 acres in the county of Northumberland. 
The extent of cleared land in the county of Gloucester was 48,639 
acres, and in the county of Northumberland 53,416 acres; the rest 
of the superficies of the holdings was in its primitive forest state. 
I annex to these answers a small map representing a portion of 
the two counties of Gloucester and Northumberland, and especially 
the section where leprosy did occur or is still in existence: the red 
colouring indicates the particular localities visited by the scourge. 
All these localities are along the littoral of the Gulf of St. Law- 
rence and of the lower part of the River Miramichi; but no deduc- 
tion can be drawn from this fact, as regards the alleged influence of 
the vicinity of masses of water on the spread and prevalence of 
leprosy, for the simple reason that the interior of the two counties 
is not settled. 
There is a uniform registration of births and deaths, but it is not 
general, being only carried on among the Catholic, population; it 
does not, however, include the causes of death. The registration has 
existed since the earliest settlement of the country by the French. 
Although many of the registers are not complete records, owing to 
the circumstance that, for certain periods of time, these populations 
were ministered by missionaries or priests having several localities 
to attend, yet they are such that the ancestry of the French-Acadian 
families can, as a rule, be traced back to their first appearance on 
this continent, by having recourse to the series of Acadian registers 
of various times and places. 
In the absence of registration among the Protestant population, I 
have had to carry on enquiry with the relatives, friends and old 
acquaintances of the Protestants who have fallen victims of leprosy, 
being nine in number. The information thus gathered by me, in 153 
addition to written accounts of the commencement of the disease, 
is sufficient, in every respect, to elucidate the essential facts relating 
to the history of each case, although it is impossible to trace the 
ancestry very far back, and although dates cannot be given with the 
same precision as such as concern the cases which have appeared 
among the Catholic population. 
A. 17.-Leprosy has made its appearance in the town of Chat- 
ham, in the parishes of Nelson, of Northesk and Alnwick, in the 
county of Northumberland, and in the parishes of Saumarez, of 
Inkerman, of Chipagan and of Caraquette, in the county of Glou- 
cester. 
The names of Saumarez and of Inkerman are the political official 
names, but the popular, historical and ecclesiastical names are res- 
pectively Tracadie and Pokmouche. Again, within the limits of the 
official parish of Alnwick there are several localities bearing 
particular designations. Two of these localities are connected with 
the history of leprosy, namely, Nigaouek and Tabouchemtek, in the 
north-eastern extremity of the county of Northumberland. There 
is to be remarked, also, that a portion of Tabouchemtek forms 'part 
of the ecclesiastical parish of Nigaouek, and that the rest is annexed 
to the parish of Tracadie. 
I have given the names of all the places where the disease has 
made its appearance: but it has not become endemic in all these 
localities. The malady has fixed itself in Nigaouek, Tracadie, Pok- 
mouche, Chipagan and Caraquette. Caraquette has furnished only 
few occasional cases, Nigaouek, Pokmouche and Chipagan a good 
many, and Tracadie the great bulk of them. In fact, this latter 
place has been, and remains, the focus of the malady, the centre 
from which it has radiated; several cases which have occurred in the 
other localities just now mentioned have originated in Tracadie. 
The two first cases of leprosy in New Brunswick do not, however, as 
well as several others, come within that catagory of Tracadian origin. 
In the following small table are given the names of the localities 
to which all the lepers existing in New Brunswick on the 15th of 
May, 1885 belong, with the population of each place, as ascertained 
by the census on the 4th of April, 1881:- 154 
Names of Localities. 
Population, 1881.... 
Lepers in Lazaretto, 
1885 
' Lepers Outside, 1885 
' Total Lepers, 1885.. 
Traeadie 
2.819 
13 
2 
15 
Pokmouche 
1.804 
4 
4 
Chipagan 
2,322 
3 
3 
Caraquette 
3,837 
i 
1 
Nigaouek 
* 2,646 
i 
1 
* Tins is the total population of Alnwick, of which about 200 are to be 
added to Tracadie, about 500 to other circumscriptions, leaving the balance 
to the ecclesiastical parish of Nigaouek. 
Before closing this brief memorandum, in answer to the interroga- 
tories put to me, I think it necessary to mention that numerous mis- 
takes, of various kinds, and very serious errors of facts, have found 
their way in papers, reports and books on leprosy, as regards the 
history and features of the disease in New Brunswick. I say so, 
simply to warn against such mistakes and errors and to show that 
the statements made here, contradictory to such, are not made in 
ignorance of what has been enunciated before. 
FROM DR. A. C. SMITH. 
A. 1.-Leprosy has existed in the Province of New Brunswick, 
Canada, for many years. It is a specific disease, characterized by 
the slow development of nodular growths in connection with the 
skin, mucous membranes and nerves, in the latter case, by the 
supervention of amesthesia, and a tendency to ulcerative destruc- 
tion. 
a. The tubercular and anaesthetic. 
b. I agree with Dr. Tachd, who has kindly allowed me the privi- 
lege of reading his replies to these questions, in his statement that 
these are varieties of one morbid state. 
c. The specific phenomena develop themselves according as the 
skin and mucous membrane on the one hand, or the nerves on the 
other, are principally affected; although in some cases all these 
tissues are implicated simultaneously or in succession. 155 
A. 2.-When resident physician I admitted boys of eight years of 
age, and one woman who was a septuagenarian. The disease, how- 
ever, is chiefly confined to young adults. 
The premonitory symptoms often continue for a long period, and 
may include lassitude and depression, accompanied by a constant 
inclination to sleep, even when at work; then follow pains in differ- 
ent parts of the body simulating rheumatism, and in turn followed 
by a train of symptoms described by Dr. Tach6 in his reply to this 
question. 
A. 3.-This depends on the age and constitutional vigour of the 
individual. The duration of the anaesthetic variety seems to be 
much longer than that of the tubercular. In New Brunswick as 
elsewhere, an essential feature in its life history is its extreme 
chronicity. 
A. 4.^-It is much more frequent in the male. 
A. 5.-The disease is at present confined to persons of French 
descent. In former years several persons of other nationalities 
have been affected, doubtless through contagion. 
A. 6.-During my residence in Tracadie I observed that the dis- 
ease appeared only among the poorer class. In one of my reports I 
stated that "as the condition of the people improved, bringing with 
it a more nourishing diet, the disease would eventually disappear.'' 
Poverty, per se, cannot cause the disease, but, because of the 
depressing influence, it seems to favour its development in persons 
who are predisposed to it by hereditary taint. 
I fully agree with Dr. Tache in his statement that "the circum- 
stances which favor the development of leprosy are the close inti- 
macy of family life and the great sociability of the people." 
a. Tracadie is on the sea-coast. 
b. The people are settled on farms; consequently, the dwellings 
are isolated and healthy. 
c. The habits of life are good. The people are religious and 
marry young. 
d. There is now abundance of healthy food to be obtained. The 
indolent ones are, of course, the poorer ones, and their diet is seldom 
wholesome. I have frequently noticed that when such persons are 
ill from serious disease they readily succumb. 
e. Fishing and farming. 
A. 7.-I beg to refer to Dr. Tachi's reply to this question, inas- 
much as mine would necessarily be similar to it. 156 
A. 8.-I am unable to adduce proofs of the hereditary nature of 
the disease, but hold that the theories of hereditary transmission and 
contagion are not incompatible. The disease frequently skips over a 
generation. 
1 have known many instances where one member only of a family 
was affected. 
A. 9.-I have no reason to suspect that leprosy in any way 
depends on, or is connected with any other disease-it is a disease 
sui generis. 
A. 10.-I have not met with instances of the disease of which I 
could affirm that they had been communicated by diseased persons; 
but I am convinced that leprosy is contagious, although not to the 
extent of other contagious diseases. The people of the leprous dis- 
trict intermarry very freely, and it is difficult to exclude hereditary 
taint. But I am confident that in former years persons free from 
hereditary taint contracted the disease, while living in Tracadie. 
A. 11.-It is not at all times easy to secure prompt removal of 
affected persons to the Lazaretto, but once admitted, segregation is 
complete and permanent. 
A. 12.-To Dr. Tachi's reply to this question I would refer for 
full particulars, which it is unnecessary to repeat. 
A. 13.-The number at the close of 1884 was twenty-two. 
A. 14.-It is on the decrease. At one time there were nearly 
forty inmates of the Lazaretto. To the improving condition of the 
people, and the segregation of those affected, 1 attribute the diminu- 
tion. 
A. 15.-As the result of long observation, I am convinced that 
good hygienic measures, including a regular system of healthy diet, 
has great power in checking rapid progress in the disease-life is 
thereby prolonged. 
I have never observed more than a temporary amelioration from 
any medicinal treatment, and only such as might be attributed to the 
influence of the mind over the body. My predecessor used coloured 
water, accompanied by strong assurances of benefit therefrom, and 
in every instance found a temporary improvement, equal in degree 
to any apparent benefit he found from the use of medicinal agents. 
I know of no spontaneous cure of the disease, although I know 
instances of temporary abeyance of the disease, lasting, in some 
cases, during a considerable period. 
As. 16 and 17.-Answers to these questions being a simple matter 157 
of ascertained statistical facts, my reply to each would be a repeti- 
tion of Dr. Tachi's reply. I therefore beg to refer to his state- 
ments. 
FROM DR. J. E. GRAHAM, TORONTO. 
1.-In New Brunswick; it occurs there in the three parishes, Tra- 
cadie, Caraquette, and Pokmouche which are situated on a penin- 
sular between the Bay of Chaleurs and the Miramichi River. 
a. There are two forms. Tubercular and anaesthetic leprosy. 
b. These two forms are but varieties of a common morbid state. 
c. The tubercular form is distinguished by the presence of tuber- 
cules of various shape and size which appear on the surface of the 
skin; most frequently on the face ; these tubercules enter atrophy or 
idcerate. 
2.-May appear at almost any age; in Tracadie as young as eight, 
and as old as eighty; the earliest symptoms are general debility, 
pain in the limbs and occasionally fever; general feeling of malaise. 
The appearance of maculae is generally the earliest positive sign. 
3.-The disease usually develops in three or four years. It 
usually proves fatal in seven or eight years. 
4.-The disease is as frequent in the male as in the female sex. 
5.-Not confined to any particular race. 
6.-It is of most frequent occurrence among people whose dwell- 
ings are small and unhealthy and whose food is poor in character. 
In Tracadie stale fish is eaten freely. 
a. It occurs frequently on the sea-coast and low damp countries. 
b. In Tracadie sanitary condition bad; dwellings small and 
unhealthy. 
c. Not cleanly. Lazy and slovenly. 
cl. Diet; potatoes, salt meat, and stale fish. Very little change 
of diet. 
e. Farmers, fishermen. 
7.-Previously mentioned condition. 
8.-It is apparently hereditary; it is doubtful as to whether it is 
really hereditary. 
9.-It is not connected with syphilis. 
10.-Have known of cases, but have not seen any. 158 
e. It is communicable by sexual intercourse. 
11.--In Tracadie they are kept in a Lazaretto, but they have 
liberty to see their friends. 
12.-A separate infirmary is provided by the Government. 
13.-About 24 or 25. 
14.-Somewhat on the decrease. 
15.-No good results from medical treatment. Much may be done 
by attending to the general health of patients. 
CANARY ISLANDS. 
DR. ANDRES NAVARRO TORRENS, DOCTOR IN CHARGE OF THE PROVINCIAL 
HOSPITAL FOR ELEPHANTIASIS OF LAS PALMAS. 
].-Without being enabled to assure ourselves to-day of the date 
when leprosy first appeared in this Province there are reasons for 
believing that the disease dates back to the conquest of these islands 
only. The most ancient chroniclers make no mention of the fact of 
the natives suffering from such disease or indeed from any other one 
analogous to it. 
a. At the present time there are, in this hospital only two kinds 
of leprosy ; that is to say:- 
1. a. Lepra tuberculosa, (Oliver) Elephantiasis Groecorum-Leon- 
tiasis-Satyriasis-Lepra Tuberculosa Leontina. 
2. a. Lepra Mutilans. Lepra ad manum pedumque articulos 
conversa (Frank), St. Anthony's Evil, (so-called by the common peo- 
ple of these islands). 
b. In my opinion, these are varieties of the same morbid condi- 
tion ; apart from the symptoms, which are common the one to the 
other, the two forms meet at times in one person and can be trans- 
mitted hereditarily indiscriminately. 
c. 1st.-Lepra Tuberculosa presents macula? somewhat reddish- 
violet, circular, raised above the skin, at first isolated and afterwards 
more or less confluent, to which frequently succeed rugosities and 
tubercules of the same color, tumefaction of the skin widely spread, 159 
accompanied by squamous patches, general loss of hair, almost con- 
stant disappearance of that of beard as well as of the eyebrows and 
eyelids; notable deformity of the features occasioned by the colora- 
tion and swelling of all of the teguments of the face; amesthesia 
which not only affects the tuberculous part of the skin but also all 
that which is hypertrophied and scaly. 
2nd.-Lepra Mutilans presents the fingers and toes arched in 
permanent semiflexion, with atrophy of the extensor muscles of the 
same ; sanious peri-articulated ulcers terminating with the falling off 
in turn of the plalanxes, skin shiny and squamous in defined regions 
and almost constantly in the elbows and knees; anaesthesia which 
affects the squamous part of the skin. 
2.-Between infancy and manhood and sometimes even in infancy. 
Lepra Tuberculosa begins with papular eruptions (similar to the 
pustules raised by the bite of the mosquito) commencing very fre- 
quently in the cheeks, lobes of the ears, elbows and knees, thus 
giving, from its beginning a peculiar appearance to the patient on 
account of the almost universal accompaniment of the puffing up of 
the skin of the face. 
Ijepra Mutilans. In this the patient begins to feel at the com- 
mencement of the disease a sensation of titillation in the joints of 
the fingers; to this follows anaesthesia of the same and the begin- 
ning of contraction. 
3.-It generally reaches its full development at adolescence. 
It commonly terminates in death at the adult age or in incipient 
old age. 
4.-I believe it is equally frequent in both sexes. 
5.-I have only seen it in individuals of the white or Caucasian 
race. 
6.-a. The dwellings of these unfortunates in this Province have 
been indiscriminately sea-coast, and city and country places having 
at times diverse conditions of soil. 
This diversity in the dwellings of the lepers is in obedience, in my 
judgment, more to a conjunction of special circumstances than that 
the localities favor the development of the disease, owing to the fact 
that it is not common for them to leave the towns in which they 
originally established themselves on account of the horror their 
miserable appearance inspired strangers to them; thus perpetuating, 
in the places referred to, leprosy by hereditary. I do not desire to 
be understood by this observation that I do not believe it to be possi- 160 
ble for leprosy to be spontaneous,-since several cases of it have 
been recorded-but the rather to accentuate the importance which in 
iny opinion heredity holds. 
b. As all the immense majority of the afliicted belong to 
the poor classes, it follows that generally their habitations are not 
healthy. 
c. d. e.-Ordinarily they have little personal cleanliness so far as 
regards washing their bodies or clothing. 
Some of the sufferers are fishermen but the greater part are occu- 
pied in field labor. 
The food usually consists of fish salted, baked or roasted with a 
piquant sauce. The poor people also frequently use maize roasted 
and ground into flour (gofio) which they eat in great quantities dry 
or kneaded with water, milk or herb broth; also baked potatoes and 
several kinds of vegetables are eaten. With the exception of the 
salt fish the basis of the food is farinaceous. 
As predisposing causes, besides those indicated and at times con- 
verting them into fixed facts, a prominent place must be occupied 
by the severe changes of temperature; and above all by the abrupt 
suppression of sweat by a sudden plunge of the body into water. 
7.-I know of no others than the lack of hygiene. 
8.-Ilereditariness figures principally as the predisposing cause, 
from first to last. 
I have seen issue by the same marriage, of which some have 
acquired the disease and others have not. 
9.-I do not believe that leprosy has any relation with the other 
affections called syphilitic, scrofulous or eruptive. 
10.-I do not know of any case of contagion of leprosy by means 
of contact more or less immediate, including sexual intercourse. 
11.-The law places no obstacle to a union of such except, the 
repugnance inspired in the minds of the healthy by their appear- 
ance. 
12.-In this hospital which has a provincial character there does 
not exist compulsory separation but a voluntary one since the former 
is at the present time forbidden by law. It is only when the lepers 
dedicate themselves to medical treatment that the authorities compel 
them to be secluded in this establishment. 
Lepers are admitted exclusively to said hospital which in early 
times was created for them. It is divided into two large depart- 
ments arranged for the separation of the two sexes. Viewed as a 161 
building excellent conditions are united in it, but its internal arrange- 
ments forbid a convenient application of a good hygienic and 
medical treatment. 
13.-At the present time there are the following inmates:- 
Ar . J Lepra Tuberculosa 20 
a e> | Lepra Mutilans • 3 
{Lepra Tuberculosa 27 
Lepra Mutilans 3 
. Lepra Tuberculosa-Mutilans 1' 
Total 54 
14.-I believe to the contrary that far from the disease referred to 
showing any increase here it is diminishing in direct correspondence 
with improved condition of the poorer classes. 
15.-I have not to this day seen any positive and evident cure of 
a radical cure by medicinal treatment. I believe that leprosy is 
incurable, (at least in the two forms which I have studied). But, it 
sometimes happens that the evolution of the disease is arrested, 
leaving the patient for a considerable time in a condition very com- 
patible with health. Without denying that medical treatment can 
materially contribute to this condition I consider that dieting is of 
great efficacy. 
In this hospital it has been observed that the disease has remained 
stationary in a few cases but it has never disappeared. 
16 and 17.-It is not possible for me to reply to these two last 
questions the import of which I do not understand. 
Las Palmas de Gran Canaria, June 1st, 1885. 
CEYLON. 
FROM DR. W. A. KYNSEY. 
1.-True leprosy is known in Ceylon and has been recognized 
since the time of the Dutch occupation of the island, the earliest 
record of the disease being connected with the asylum founded and 162 
transfered to the British Government by a Dutch lady who was her- 
self a leper. It was known to the Sinhalese from a remote period as 
a skin disease under the name of "Gaja Charma" or Elephant-Skin, 
in association with other cutaneous disorders and has been more 
recently mixed up with " Parange" a prevalent local disease, having 
a close resemblance to the "yaws" of the West Indies. It exists in 
every form and phase, the amesthetic being perhaps the most .fre- 
quent, among the fish-eating population on the sea-board and in Co- 
lombo, the chief city of the island. 
It is considered a constitutional disease "sui generis" and occurs 
in three principal forms, which in my opinion, are only varieties of 
one common morbid state. 
The tubercular variety is recognized by the appearance of tuber- 
cules, erythematous raised patches and infiltrations of the skin 
involving the face, forehead and ears, lending the countenance its 
sinister aspect, and the trunk and extremities, with little or no 
diminution of sensibility, by the characteristic nasal voice, fissured 
and tuberculated condition of the tongue and palate: tumefaction of 
the fingers and toes, ulceration of the matrices and falling off of the 
nails ;-swelling and hypertrophy of the feet and legs. With these 
are associated febrile reactions with eruptions of livid swellings 
(elephantoid fever) and frequent ulcerations and healing of tuber- 
cules. 
The anaesthetic form is usually distinguished by maculae or spots 
of a tawny color on a level with the skin which is usually scaly, dry 
and wrinkled in appearance, normally sensitive at first but gradually 
becoming benumbed in their centres, and inclined to spread and 
coalesce, forming extensive serpiginous patches generally following 
the course of nerves and often symmetrically arranged on the trunk 
and extremities. There is numbness commencing at the great toe or 
in the course or distribution of the ulnar and median nerves, involv- 
ing subsequently the whole of both extremities up to the elbow and 
knees, flexion of the fingers on the palms, followed by the appear- 
ance of blebs or bulla? spontaneously or by proximity of the limb to 
a fire; and the supervention of unhealthy ulcerations resulting in 
necrosis and exfoliation of the bones and loss of fingers and toes, 
and ending in gangrene. Dry munification of the extremities is 
frequently noticed with a shrivelled and fissured condition of the 
nails. A characteristic indolent ulcer is often found on the plantar 
surface of the great toe on the metatarsophalangeal joint, or at the 163 
heel. The ulnar and median nerves are felt enlarged and thickened 
at the elbow and wrist. With loss of cutaneous sensibility there is 
also loss, sooner or later, of thermic and pain sensations; atrophy 
of the muscles of the arm and hand giving the latter its talon-like 
form, known as the bird-claw hand ; and distortion of the feet with 
luxation at the ankle. The glands of the groin are invariably en- 
larged and prominent. In its permanent stage muscular paralysis 
and wasting supervene the arbicularis muscles, and muscles of the 
arms and legs become affected; extropion, eversion of the lips, 
wrist-drop, Keratitis with loss of vision and atrophy of the structures 
of the eye usually ensue. There are no febrile attacks with livid 
eruptions pathognomonic of tubercular leprosy in this form of the 
disease. 
The mixed variety has, most if not all, the characteristic phen- 
omena of the preceding forms, and is found more frequently 
associated, as the records of the Asylum show, in hereditary cases. 
Mutilations occur, but are not so extensive as in the anaesthetic 
variety, the loss of cutaneous sensibility is markedly evident in the 
extremities; the tubercles ulcerate and heal, but there is no super- 
vention of gangrene. Death usually occurs in leprosy front diarrhoea, 
dysentery, general dropsy, tuberculosis and from exhaustion from 
long continuance of the disease itself. 
2.-At all ages from childhood to advanced life. I have not seen 
children born with the disease, but have observed anaesthetic leprosy 
in a child of three years, and well marked tubercular leprosy in 
children of nine and eleven years. There is at present a female in- 
mate in the Asylum who has clearly manifested the disease in her 
fifty-seventh year, long after her two sons were affected with it. 
The earliest symptoms in the anaesthetic form are usually indicative 
of some nerve lesion, as shooting or darting pains in the limbs, loss 
of morbility of the fingers, burning sensations in the feet, form- 
ication all over the body, followed sometime after by loss of cutan- 
eous sensibility, contraction of the little fingers, and the appearance 
of tawny-colored, benumbed spots on the face, trunk and limbs. 
In the tubercular form the premonitory symptoms generally ob- 
served are a feeling of malaise, unusual drowsiness, vertigo, 
epastaxis, profuse sweating on the least exertion, the appearance of 
livid blotches with fever, attended with rigors, and tumefaction and 
thickening of the lobes of the ears. 
In well-marked mixed leprosy, the fever and erythematous rash 164 
are generally associated with commencing numbness of the fingers 
or a benumbed, discolored patch on the body and the occurence of 
blebs on the extremities. 
3.-The disease attains its full development, sooner or later, ac- 
cording to the circumstances and condition of the patient and the 
state of his general health. From ten to fifteen years is about the 
usual period; rarely the disease remains normally arrested for years. 
It usually proves fatal at middle age; the longest duration of the 
disease recorded in the Asylum for the tubercular form was sixteen 
years, anaesthetic twenty-eight, and mixed twenty-one years. 
4.-The disease appears more often in men than in women in the 
proportion based on the figures in the records of the Asylum of 
eight to one. 
5.-In this colon}7 it is not exclusively confined to any community, 
but is more frequently observed among the Sinhalese and Tamils, 
seldom among the Eurasians, and more rarely among Europeans. 
G.-Chiefly among the poorer classes such as cultivators or field- 
laborers, mechanics, cart-drivers, coolies or day-laborers, fishermen, 
and others whose occupation expose them to vicissitudes of weather 
and extremes of hot and cold. 
It occurs more frequently on the western and southern sea-coast 
of the Island and in Colombo, the chief city, on the banks of rivers 
and littoral lakes, .in low, more or less damp and malarial localities. 
Sanitation is not much observed among the poorer natives, whose 
dwellings are usually small, thatched huts, ill-ventilated and crowded, 
with the immediate neighborhood filthy and strewn with mouldy and 
rotten vegetation and excremental deposits ; their clothing deficient; 
their diet poor from insufficiency of nitrogenous elements, consist- 
ing chiefly of dry and salted or badly preserved fish, often in a rot- 
ten state, and inferior grain and vegetables; and their occupation, 
that of cultivators or coolies. 
7.-All the above insanitary and unhygienic conditions associated 
with intemperance, sexual excesses, neglect and exposure; want of 
personal cleanliness; improper treatment by native practitioners and 
the abuse of mercury and opium. Most of the patients admitted 
into the hospital with the disease in its most aggravated form had 
been previously salivated or were habitual opium-eaters. 
8.-A hereditary taint is frequently admitted by the patients in 
the Asylum, and several instances are on record of one or two mem- 
bers of a family being affected while others remain exempt from 
any trace of the disease. 165 
9.-I have sometimes found it connected with Scrofula, Sy- 
philis and Parangi; but have no reason to believe that it is any way 
dependent on these diseases. Leprosy also occurs associated with 
Scabies, Eczema, and Psoriasis, and other skin diseases 
among the fish-eating population of the island. I have seen it in 
connection with Elephantiasis Arabum. 
10.-It is not considered contagious in Ceylon, and lepers are not 
generally shunned by their relatives or friends for fear of infection, 
but are often maintained by them in their own houses. It is in my 
opinion not contagious as Syphilis, Parangi, or the exanthem- 
atous diseases. There is no conclusive evidence in the Hospital 
records of communicability by direct contact with or close proximity 
to diseased persons. The attendants of the Hospital have for years 
been in close association with the lepers in all stages of the diseases, 
the head-servant for more than twenty years, and the washing of the 
establishment has been performed by a family in the neighborhood 
for four generations, but not a trace of the disease as I have reason 
to know has been observed among them. 
It certainly does not appear to be transmissible by sexual inter- 
course, as there are numerqus instances to my personal knowledge 
of leper wives and husbands who have not contracted the disease 
from each other. 
11.-There is no restriction imposed or segregation enforced by 
legislative enactment or otherwise in respect of lepers in this Colony, 
who are allowed to mix freely with the people and are frequently 
met with in crowded localities in town as mendicants, and only 
brought into the Asylum when they become physically disabled and 
can no longer follow their lucrative calling in the streets. A partial 
restriction is perhaps observed among the home-dwellers in villages 
which are as a rule sparsely populated, a single family being afflicted 
and remaining voluntarily isolated from the rest of the community. 
12.-An Asylum has been in existence prior to the commence- 
ment of the present century, probably from the time of the 
British occupation of the Colony, transferred to the Government, it 
is believed, by a Dutch lady as a home for lepers. It occupies a 
beautiful site in an isolated locality, four miles from the fort of 
Colombo, on the bank of the Kelani river in close proximity to the 
sea, and is well adapted, since the recent improvement it has under- 
gone, for the seclusion and treatment of lepers. It consists of twelve 
wards having accomodation for 159 patients in separate blocks or 166 
pavillions, well lighted and well ventilated, to which are attached 
latrines worked on the dry earth system and lavatories for hot and 
cold baths; the female wards being separated and isolated from the 
male by a partition wall. The Asylum is in charge of a resident 
medical officer under the supervision of the Principal Civil Medical 
Officer, and is wholly supported by Government at an annual cost to 
the Colony of Rsl5,400. The dieting of the patients is according to 
the dietary scale for all the hospitals m the island, but more variety 
is observed in the distribution of the diet to suit the dyspeptic tend- 
encies and voracious appetites of the patients, while extras are also 
liberally supplied when necessary, cleanliness is strictly enforced, 
river and sea-bathing are constantly practiced ; the clothing changed 
twice a week, and the bedding aired as often as possible. The 
adult males are daily employed, excepting Sundays, in various occu- 
pations as ward attendants, etc., and in the gardens which they 
cultivate with vegetables for their own use ; the females are occupied 
in sewing or in plaiting cadjans, and the children attend schools under 
leper teachers. A Roman Catholic chapel and Budhist temple have 
also been provided them for religious purposes by the charitable con- 
tributions of their friends. 
Lepers are not usually admitted into the general hospitals of the 
island, but are sometime,detained in them till they can be sent to the 
Asylum. 
13.-The daily average of lepers in the Asylum maintained by the 
Government for the last five years was 125. 
14.-The disease I have reason to believe, has decidedly increased 
since 1862, as the number of patients then in the Asylum was 63, 
but it has since increased to 151, being the maximum number 
treated since the beginning of the present year. Its increase 
among the general population cannot be established with precision 
owing to the absence of an exact registration enumerating lepers. 
Cases of strictly recent origin are relatively more frequent judging 
from the admissions into the Asylum, and the numerous instances 
that have come under my personal observation among the general 
community. I have no doubt that a certain reproduction of the 
disease is going on whatever the factors are at work, and that the 
proportionate growth of leprosy in the Colony, is by no means dimin- 
ishing. Immigration from India of Malabar coolies infected with 
the disease has, in a great measure, contributed to the increase of 
pauper lepers in the island. 167 
15.-No treatment as yet has been found of any permanent 
benefit, Chaulmoogra oil (Oleum Gynocardim Odorata) has given 
beneficial results in the amelioration of some of the symptoms, such 
as the absorption of tubercles and healing of ulcers, Gurjun or 
wood oil, obtained from various species of Dipterocarpi used 
externally and internally, appears to retard the progress of the 
disease, but has never in any instance proved curative. Carbolic 
oil inunctions (1-40 Cocoanut oil) and vapor baths, Quinine 
and Iron, dilute Nitro; Hydrochloric acid in bitter infusions, 
Liq. Arsinicalis and Sulphur, where there are skin complications, 
and the Ferri. lodid are the usual remedies employed in the 
Asylum, and have been found useful in improving the general 
health and amending the constitutional taint. As frequently the 
best results have been obtained from hygienic and dietetic treatment 
alone. 
There is at present in the Asylum a Malabar patient in good 
general health admitted with amesthetic leprosy, in whom the disease 
had been fully developed, whose case may be considered a spontan- 
eous cure, no further symptoms having appeared during the last six 
years. The disease having apparently exhausted itself. 
I cannot confidently assert that any patients have recovered under 
treatment, but a large proportion has been benefited and taken 
their discharge, and a great many more are now in the Asylum in 
ordinary good health without the appearance of fresh symptoms or 
any further progress of the disease for some years. 
16.-By the last census on February 17th, 1881, the population 
was 2,759,738. There is a uniform registration of births and deaths, 
including the causes of deaths, existing since 1867, kept at the office 
of the Registrar General. 
17.-In the Western Province including Colombo, the chief city 
of the Island, with a population of 897,329, and the Southern 
Province, including the township of Galle, with a population of 
433,520. In the absence of statistical records on the subject, I am 
unable to give the number or proportion of lepers in these townships 
and districts. Leprosy is very unfrequent in the hilly districts of 
the Central and is but rarely observed in the other Provinces of the 
Island. 168 
CHILI. 
FROM D. THOMAS, ESQ., 11. II. M'S., CHARGE 1)' AFFAIRES FOR CHILI. 
Sir :-I have the honor to acknowledge receipt of Your Excel- 
lency's dispatch No. 1, under date of 25th March, the contents of 
which have had my attention. 
Leprosy.-After making full enquiries from the principal medical 
gentlemen of this country, I have received the same answer from all, 
viz., that leprosy does not exist in Chili. It would be useless there- 
fore to forward all the answers I have received, I therefore only en- 
close the one I received from Dr. J. J. Aguirre, Dean of the Faculty 
of Medicine of Santiago, Chili, with a translation. 
" It woidd appear that leprosy does not exist in Chili. In none of • 
the scientific publications do we find any case mentioned of this 
disease. In our own practice we have never observed any cases 
that could even vaguely appear as leprosy. We have consulted with 
sundry colleagues on the subject and from all we have received an 
answer in the negative. Consequently there does not exist in Chili 
laws or institutions relating to this subject. 
(Signed.) "J. Joaquin Aguirre, 
" Deacon of the Faculty of Medicine." 
FRANCE. 
DISCUSSION BEFORE THE ACADEMY OF MEDICINE, PARIS, ON THE TRANS* 
MISSIBILITY OF LEPROSY. (LE TEMPS, PARIS, OCTOBER, 1885). 
Is Leprosy contagious? This is the question which M. Vidal, 
medical director of the St. Louis Hospital proposed to solve in a 
memoir which he has presented to the Academy. 169 
M. Vidal believes in the contagious propagation of leprosy, and in 
this he only follows the general opinion. Both in Europe and in the 
East in the Middle Ages the leprous were secluded in special es- 
tablishments, with the object of isolating them and extinguishing the 
malady. 
An European doctor, who was in the East, has proved that in 
fourteen cases of leprosy the malady had not been transmitted by 
heredity. 
On the other side, it is alleged that lymphatic influence and 
scrofula have their weight in producing leprosy. 
Practical experiments in the inoculation of animals with leprosy 
have given no result up to the present date. Nor is phthisis, in 
spite of its being contagious, inoculable. 
Without doubt, the medical faculties assure us that in North 
America the propagation of leprosy is so constant and so regular 
that contagion alone can explain it. 
In the Hawaiian Islands leprosy was unknown until the year 1848, 
when it was introduced by the Chinese; to-day it has attacked a 
twentieth part of the population. 
Practical observations on the Island of Mauritius, analagous to 
those to which I have just referred, also prove its contagiousness. 
Leprosy was there also unknown until the year 1765 ; now it has at- 
tacked the inhabitants by the thousands. 
In the Middle Ages, the isolation and the treatment employed in 
the hospitals victoriously combatted the disease, which had then 
become endemic. In the fifteenth century leprosy disappeared in 
the European countries, but even to-day persistently remains in 
Scandinavia. Without doubt, thanks to the improvement in hygiene, 
the malady is diminishing; in the space of twenty years, from 1860 
to 1880, the number of lepers have decreased in Norway from 3,000 
to 1,498, and nearly all of them have acquired the disease through 
heredity. 
M. Vidal thinks that the prophylactic resources employed against 
leprosy should be in proportion to the grade of civilization of the 
people; they should be energetic if those for whom they are applied 
have not the knowledge of the efficacy of the necessity for hygienic 
rules, and always having for an aim the convincing of the public 
mind of the importance of hygiene. 
M. Hardey puts a side question in regard to the etiology and the 
propagation of leprosy.-He wished, he said, to abide by clinical 170 
facts ; leprosy, according to him, is not contagious in those countries 
in wjiich it habitually reigns. He had observed in Paris numerous 
cases of leprosy which in the absolute had been contagious. In or- 
der that the contagion of the disease should establish itself, special 
local conditions were required which were wanting in our boundaries. 
"Be it so," replied M. Vidal, " in France the climatic conditions 
and the regular habits and cleanliness, constitute, it may be, in- 
superable obstacles to the propagation of leprosy." 
" In my recent visit to Constantinople," said M. Dujardin-Beau- 
metz, " I had an opportunity to observe some 3,000 lepers, of which 
number a part were in the hospitals and the rest wandered free about 
the streets. One could visit, without great difficulty, the hos- 
pitals, although they are not often visited by the superstitious people 
who believe that visiting the lepers attracts to their hearths all man- 
ner of diseases. It is not a rare thing to see lepers marry with 
healthy women, without contagion resulting to the women or 
children. 
" The lepers who wander around the streets, roughly calculated at 
200, more or less, are many with healthy women, or with lepers like 
themselves. There are authors who vacilate by saying that leprosy 
may be hereditary; and without any doubt, I have seen lepers, the 
children of lepers. 
"The experimental physiologists say that since there exists a 
microbe of leprosy there must of necessity exist contagion. I am 
not of this opinion; there may very well exist the microbe, without 
there necessarily being contagion. Thus, for example, intermittent 
fever, which has its microbe, is not contagious; but above all, we 
must not forget that even now the existence of a leprous microbe 
must be proved." 
M. Paul Constantine said, that the problem of contagion swayed 
between two contrary opinions. Medical authorities worthy of re- 
spect, denied the contagiousness; European doctors all followed 
this theory, and what is certain is, that inoculations have given no 
results; it is left therefore for us yet to judge from testimony 
from farther abroad, and this is not very well proved. 
M. Leroy de M6ricourt testified that M. Brassac, Naval Surgeon, 
who had carefully studied leprosy, would not admit its contagion 
but believed in its hereditary transmission. 
M. Lagneau observed that in early times there existed in Western 
Europe a firm opinion that leprosy was peculiar to the people of the 
North. 171 
Baron Larrey said that his father, who had the opportunity of 
studying the disease in Egypt, did not believe in its con- 
tagiousness. 
M. Vidal in replying to his opponents, said, that in the Hawaiian 
Islands leprosy generally is not hereditary; that the malady could 
not be attributed to misery nor to the use of decomposed fish ; that 
in India there were 102,000 lepers who absolutely did not consume 
fish ; that leprosy could not be attributable to the climate since it ex- 
isted in every country; that it is not inoculable; that it could be 
contagious in a lingering manner, and even latent, as has been proved 
in many cases; and finally, that the opinion in regard to contagion 
stood, as they say, in secular possession of the scientific domain, and 
that it behooved its adversaries to refute it. 
THE NEXT SESSION. 
M. Leroy de Mericourt continued the discussion on the question 
whether leprosy was contagious or not, the discussion commencing at 
the previous session. M. Vidal, to prove propagation by contagion 
of this malady in the Sandwich Islands, produced a memoir by Mr. 
Woods, an American doctor. M. Leroy de Mericourt analyzed and 
criticized the most notable passages in the memoir, and his criticisms 
resulted that the opinion of 3Mr. Woods lost much of its weight by a 
considerable conjunction of facts. In the year 1555 the Port- 
uguese had visited those distant shores, and there is no doubt that 
later on the expedition of Captain Cook carried there syphilis, it be- 
ing a well known thing to many doctors, that leprosy is but a trans- 
formation from " syphilitic cachexia." The Hawaiian Islands are 
under the tropic of Cancer; its climatic condition, the licentious 
customs of the inhabitants, favored there the development of all in- 
fectious diseases; and, in a word, if leprosy had been imported into 
those Islands, it must have been at a very remote epoch, and that 
the case to which they referred of a Chinaman who was the first to 
be attacked by this disease in 1848, must be regarded as a tale. 
Syphilitic cachexia and scrofula have existed in Hawaii and the other 
Islands of the Pacific for a much longer time. 
M. Leroy de Mericourt was not altogether assured of the recent 
importation of leprosy in the Island of Mauritius; from very remote 
times there had existed very frequent commercial relations with the 
Indies and all the western coast of Africa. 
Leprosy is a bacilarial malady, whose propagation remains buried 
in obscurity; its hereditariness, certainly cannot be denied as being 172 
one of the forms of its propagation; these may also be the intro- 
duction into the blood of morbid materials, proceeding from the 
leprous ulcers; but leprosy is not contagious in the sense we give to 
that expression, in the same way as small-pox, typhoid fever and 
cholera. • 
The microbian doctrines have caused the evil of propagating 
through all parts the idea of contagion, producing among the 
public a true and very serious pre-occupation. For their part, 
these doctors have seen on every side whole armies of morbid germs, 
and this illusion has made them carry out the isolation of the 
diseased even to the very limits of ferocity. If this movement is 
not restrained, we shall arrive at seeing as many wards of isolation 
as there are different diseases in existence. It is about time that we 
cast away from ourselves all these notions, and moulded ourselves 
to new ideas more in harmony with truth and reflection. 
M. Vidal replied to all this: Leprosy and syphilis should not be 
confounded in their manifestation; that both could be presented at 
the same time and in the same subject and mutually develop; and 
that the word syphilis could not be translated into that of leprosy, 
according to the authors whose testimony he had invoked. M. Vidal 
insisted on believing in the cases pointed out by Mr. Woods, as hav- 
ing occurred in Hawaii, and that they could not be explained either 
by spontaneous generation, resulting from alimentation, misery, 
etc., nor by heredity; they had their origin without doubt, in the 
importation of the plague in the year 1848. The rapid develop- 
ment of leprosy from this date, necessarily implies the existence or 
the possibility of contagion. In the opinion of M. Dujardin-Beau- 
metz a bacilarial malady, the marsh fever, for example, may be 
baeillarial but not contagious, not even by inoculation. Might I 
not record, said M. Vidal, recent experiments which appear to 
indicate the possibility of inoculating the marsh fever. 
M. Leroy de M6ricourt supported the opinion of all the Naval 
Surgeons, who had observed the malady in every latitude and did 
not consider it contagious. 
M. Jules Rochard observed that, in his opinion, it was not certain 
that leprosy had been imported into the Sandwich Islands in 1848, 
since M. Quoy had seen it there since 1819, when he made his voy- 
age of circumnavigation. 
M. Vidal replied that the terms of M. Quoy's statement appar- 
ently referred to syphilis and elephantiasis more than to leprosy. 173 
GUATEMALA. 
FROM DR. MIGUEL VALLADORES, PHYSICIAN OF THF. LAZARETTO, AND 
DOCTOR JOAQUIN YELA, DIRECTOR OF THE PURLIC 
HOSPITAL AND ASYLUM, GUATEMALA. 
1.-Yes. 
a.-Three; tuberculous, amesthetic, and one which is a combina- 
tion of both of these. 
6.-It is one and the same disease, with different symptoms. 
c.-In the tuberculous form, enlargement of the ears (which is the 
place where the disease generally first begins to show itself,) the com- 
plexion of the face is changed to a copper hue, eyelashes and eye- 
lids and brows fall off. In the anaesthetic form the patient has no sense 
of touch or temperature; pricking him with a needle, he does not 
feel it; eyelashes and brows fall off, also lower eyelid; he suffers 
from muscular atrophy. 
2.-The disease is most frequently met with between the age of 
twenty and forty. I have met with only two patients of tender age, 
one of six and one of seven years of age, but I have heard of two 
or three cases, where the afflicted were twelve to fifteen years of 
age.* 
The first symptoms are: rose-colored spots on the face and other 
parts of the body; these spots grow darker and gradually change to 
a purple color; when these spots disappear, the skin thickens where 
these spots have been. In the amesthetic form these spots do not 
appear; this form immediately commences with insensibility with 
the lower or upper parts of the body- 
The development of the disease has no fixed time; the younger 
the patient the more rapid the progress of the disease. I know of 
cases where the patients have neither improved nor become worse 
for several years, but as a rule, the disease terminates fatally in 
from four to eight years. 
*The doctor speaks of the patients he has treated in the Leper Hospital; 
well-to-do families contrive to secrete an afflicted member of the family in 
some remote place; this to my personal knowledge, -H. H, M's. Consul. 174 
4.-Amongst men; nine men to six women. 
5.-In Guatemala it is an almost unheard of thing for an Indian 
to be afflicted with leprosy; my patients have all been " Ladinos," 
(descendants of Spaniards and Indians!). 
6.-a. On the sea coast which is low; and in the Department (or 
province) of Quezaltenango, which is 6,000 feet above the level of 
the sea, and the coldest region of this republic, leprosy is 
but little seen. 
Near the {Capital, where the climate is very variable, is the spot 
where leprosy most exists. 
b.-The dwellings are generally a house of two or three rooms; 
houses built of "adobe" and covered with brick tiles, slanting 
roof. 
c.-People of the lower class, who live on the cheapest kind of 
food and give no attention to cleanliness. 
d.-Plantains, bananas, beans, (fried in lard) ; work only when 
absolute necessity compels them. 
e. -Farm- h an d s. 
7.-Want of fresh air; the custom (amongst the poor class) of 
whole families sleeping in one room ; want of cleanliness, and use of 
alchoholic liquors. 
8.-Yes; I think it is often hereditary; but I know of three 
instances, two of which, in which the father, and one, in which the 
mother, were afflicted with leprosy, and although the parties were 
well aware of their disease, they cohabited, and the children bear no 
trace of the disease; but in one of these cases, (where the father 
was a leper) the daughter married, and her child had the disease. 
I am convinced that the disease will re-appear in the second gener- 
ation. I know of several instances, where a member of a family 
had this disease, and the other members of the family were exempt 
from it. 
9.-I know' of only one leper who wras syphilitic before being at- 
tacked with leprosy; my other patients have had no syphilis, more- 
over, I have observed that a mercurial treatment aggravates the 
disease of leprosy in a patient. 
fBy H. II. M's. Consul. This statement, although verified by other doc- 
tors, must be taken "cum grano salis," as there are plenty of Indian villages 
and settlements, which are rarely, if ever, seen by a doctor. 
J.5.000 feet above the level of the sea. and where there are scarcely any 
pure Indians.-H, H. M*s. Consul. 175 
10.-1 have not. 
10.-c. I think it is; refer to question 8. 
11.-No; they are strictly segregated.§ 
13.-Nine men and six women. 
14.-The disease has increased in Central America, because the 
lepers were not until lately segregated, and memb'ers of families 
known to have leprosy were allowed to marry ; while it is a known 
fact, that although the son or daughter of a leper may bear no vis- 
ible traces of this disease, the grand-children are sure to be 
leprous. 
15.-Lepers should have plenty of fresh air, wear flannel clothing, 
bathe every day in tepid water, eat roast meat, thick soaps and 
milk. 
I use in the treatment, astringents both internally and extern- 
ally. Two grammes tanuid, and one of extract of ratania, make 
twenty pills, to take four per day. Exterior treatment: one gramme 
acido fenico, with thirty of glycerine, and fifty centi-grammes 
borato de soda; to be well rubbed in twice a day for about half an 
hour each time; for ulcers, two grammes iodoformo and thirty of 
vasaline. This is my treatment of the tuberculous form. In the 
amesthetie form, I have noticed that internal astringents are of 
great benefit, also electric currents ascending the back-bone. 
I have never seen or heard of leprosy undergoing a spontaneous 
cure; of my patients in the Hospital, two were partly cured in the 
third stage, and one radically in the second stage, the two former 
antesthetic, and the latter one tuberculous. 
16.-Republic, 1,400,000 (of which two-thirds are full blood 
Indians). 
Capital 60,000 last year. 
Yes ; since eleven years ago. 
§See question No. 2. -H. II. M's. Consul. 176 
HOLLAND. 
FROM DR. EGELING, STATE MEDICAL INSPECTOR FOR THE PROVINCE 
OF YNID. 
Leprosy is rare in the Netherlands, and even then is almost in- 
variably seen in persons coming from the Colonies. Isolated cases 
are known in which the disease is hereditary. 
In May 1867 the Medical Inspectors assembled and discussed the 
question of leprosy as exhibited by the appearance of the patients at 
Brombeck. The results of their investigations are to be found in 
their report, volume 1, folio 233-235; also in the annual report of 
the State medical inspection for the same year, folio, 199-242. 
1 remember that it was proved in an enquiry held by the Royal 
Academy in 1847, that no cases of hereditary leprosy could be 
shown in twenty-five years. 
In order to gain further information in regard to the appearance 
of leprosy in the Netherlands, I made enquiries as to the cases in the 
larger hospitals of the country at Amsterdam and Rotterdam. For 
that reason I have been unable to reply sooner. From Amsterdam I 
am informed that the number of cases is so few that there is not one 
a year reported, and such as there are, are invariably from the 
Indies. 
The presiding physician of the hospital at Rotterdam who has 
been at the head of this establishment forty-two years has not seen 
a single leper in that time. 
Another physician, who had been even longer at this Hospital, re- 
membered a man whose disease was elsewhere thought to be leprosy, 
but according to his convictions it was not leprosy but syphilis. This 
man came from Borneo. 
Leprosy has not been the subject of special legislation in the 
Netherlands as there was no reason for it. 
It is not necessary to speak of the laws of centuries ago concern- 
ing the lepers of Melaatschen. These were for the most part suffer- 
ers from syphilis. 
The Consul asks whether the Government enforces separation? A 177 
long time ago, driven through unsufficiently grounded fear, some 
lepers were transported from Brombeck to Veenhuisen and there 
forcibly segregated. 
I do not know whether this still happens. Other lepers, dwelling 
at Brombeck, who did not go to Veenhuisen, have rejoined common 
society without any harm resulting therefrom. 
In the fourth place it is asked, do any hospitals or asylums for 
lepers exist in the Netherlands or its colonies? This question must 
be answered negatively unless the Veenhuisen incident is con- 
sidered. 
Fifthly and finally the Consul asks, "What is the prevalent pop- 
ular opinion as to contagiousness of leprosy, and do healthy persons 
carefully avoid those who have the disease? " 
The conviction, it can easily be seen, of all whose opinion has any 
value (for in such a case the popular idea of the ignorant is certainly 
quite unreliable) is that leprosy in the only forms in which we see it 
in the Netherlands, is not transmitted from one person to another, 
(except as hereditary disease). 
And since the disease so seldom occurs, there is little need for 
avoiding those who are afflicted with it. It proves nothing that 
some people are afraid of a leprous patient. 
The Inspector for the State Medical Bureau, for the Province of 
Ynid, Holland. 
(Signed.) EGELING. 
HONGKONG, 
FROM HON. WM. KESWICK, HIS MAJESTY'S CONSUL GENERAL AT 
HONGKONG. 
To His Excellency Walter Murray Gibson, 
Minister of Foreign Affairs, Honolulu. 
Sir:-Referring to my letter of the 12th of March, I have now 
the honor of laying before you the result of my enquiries as to 
Leprosy. 178 
It does not prevail to any extent in this Colony. 
The only legislation with regard to it is in the following section of 
an Ordinance: 
" Every master of a junk, vessel, or boat, bringing into the 
Colony or from one part of the Colony to another, any person who 
shall in the opinion of the Court before which the offence shall be 
tried have come to the Colony for the purpose of mendicancy, or 
any person suffering from leprosy or any contagious disease, shall 
incur a penalty not exceeding ten dollars for every such person so 
brought by him as aforesaid." 
There are cases amongst the lowest class of Chinese which how- 
ever have not been treated by European practitioners. I am there- 
fore unable to return the printed form filled up as you desired. 
I have the honor to be sir, your most obedient servant, 
WM.-KESWICK. 
MEXICO. 
DR. JUAN M. GOMEZ, DIRECTOR OF THE LAZAR DEPARTMENT, JUAREZ 
HOSPITAL. 
There is in Mexico a malady known as "Mal de S. Lazaro," (St. 
Lazarus' evil) the symptoms of which correspond with the disease 
commonly known under the name of Elephantiasis Groecorum, and 
which some European doctors have also called leprosy. 
The following replies refer to the " Mal de S. Lazaro:" 
1.-The " Alai de S. Lazaro " exists in Mexico, and principally in 
its western regions. 
a.-This disease shows itself under the following forms; tuber- 
culosa, anmsthetica, and Maculosa: 
The tubercular form; characterized by the dropping of the ex- 
ternal part of the eyelids, and by the existence of tubercules which 
appear on the forehead, the face, the supraciliary region, the ears 
and on the outward face of the arm, and the back of the forearm. 
The anaesthetic form has as its characteristics the reabsorption of 179 
the tarsal cartilages; of the muscular masses of the thenar and hip- 
othenar regions; and the retraction of the muscles and tendons of 
the flexors of the fingers. 
And last, the macular form: this is characterized by the appear- 
ance of irregular macuhe which generally appeal; on the limbs, and 
by falling out of the hair; much more notable in these diseases 
since the complete falling off of the eyebrows and the hair of the 
breast has been observed. 
b.-It is believed they are varieties of the same disease; they 
combine one with the other; for instance, two in one and the same 
individual. 
c.-There is anaesthesia in the three forms; in the macular, 
gangrenous, even-speckled macuhe ; in the tuberculous, hard tuber- 
cules similar to syphilitic tubercules; and in that called anaesthetic 
there is a reabsorption of the osseous texture, and of certain cartil- 
ages ( the tarsal ) and the amesthesia is more extended and 
profound. 
2.-It generally appears from seven to thirty years of age, but 
there are cases in which it has appeared at forty and fifty. The 
first symptoms are ordinarily a lack of the transpiration of the pers- 
piration of the feet and legs with increased sweat on the rest of the 
body, dryness in the nasal fossm, and falling of the external parts 
of the eyelids. Accompanying these phenomena are a burning 
sensation in the members of the body and a little amesthesia. 
3.-The greater number of cases occur in youth or at a mature 
age. The diseased who suffer from the macular form die w'ithin ten 
years, counting from the date of the appearance of the disease; 
those from the tuberculous form within fifteen years, and those with 
the anaesthetic form may linger for thirty years or more. 
4.-The " Mal de S. Ldzaro" is more frequent in the masculine 
sex ; in the proportion of eight to five. 
5.-No preference of this disease has been noted for any special 
race or color; except, it may be stated, that no negro with this 
disease has yet presented himself at this hospital. 
6.-The " Mal de S. Lazaro " afflicts almost entirely the poorer 
classes of the people, and generally affects such persons as fre- 
quently expose themselves to moisture and heat alternately. 
a.-It is most frequent in small populations, and in the country, 
in places near to the coast, in the bays and in moist and marshy 
spots, 180 
b. -The condition of the dwellings may have some influence over 
the development of this disease, taken in connection with the sub- 
stance of the reply in No. 6. 
c.-The habit of taking considerable alcohol appears to influence 
the development of- the disease in persons predisposed to it. 
d.-The larger number of cases of "Mal de S. LAzaro " are 
noted in those places where pork is much used for food. 
e.-The " hizarinos " (lazars or lepers) are mostly herders, out- 
doormen, or laborers who are for the best part of their lives close to 
a fire, and frequently exposed to the cold air and dampness. 
Abuses of all kinds, excesses in eating and drinking, exposure to in- 
tense heat and cold encourage the symptoms of the disease and 
hasten its fatal termination. 
8.-The "Mal de S. LAzaro" is hereditary, and is assuredly trans- 
mitted by the mother; but if the mother is healthy it has not yet 
been determined how it is transmitted. I know a family in which 
only one of its members has any symptoms of " Mal de S. LAzaro '' 
of the anaesthetic form; the family consists of four persons. The 
father died of the disease, the mother is healthy. 
9.-I do not believe this disease has any connection with syphilis. 
Anti-syphilitic treatment breaks down. 
10.-There is not a single case of contagion either direct or 
through proximity to the disease. 
a.-(No reply). 
b.-(No reply). 
c.-There has been no case of transmission of the disease by 
sexual intercourse. 
11.-Those sick from this disease, of both sexes, are placed in 
different wards. 
12-There was formerly a special hospital for those suffering 
from this malady, but now they occupy wards in a civil hospital. 
The sanitary conditions of the hospital in which they at present 
reside are good. The sick occupy rooms well ventilated and ample 
in size, and have also an open yard or garden, in which they can 
spend a few hours of the day according to the directions of the 
medical attendant. 
13.-Ordinarly there are thirty patients in the two wards. 
14.-This malady has been known in Mexico from the time of the 
conquest, since Hernan Cortes founded a hospital specially for the 
lazars. As regards the increase or decrease of this malady there has 
been no notable change. 181 
15.-The only favorable results obtained have been an alleviation 
of the sufferings of the sick. Hygienic measures are very useful 
and necessary. Nitrogenous food and the deprivation of all alco- 
holic beverages have also been found beneficial, and with respect to 
the medicinal treatment, outside of the symptomatic, I have only 
noted any decided improvement when the sick have been treated by 
the Sudorific method, with hot air and vapor baths and by the ad- 
ministration of medicines which directly excite the perspiratory 
glands. 
I have never seen a spontaneous cure of this malady. 
During the whole of the time I have had charge of the lazar de- 
partment (twelve years) not a single case has been restored to 
health, except one of the tuberculous form to which supervened in- 
tense albumenuria, and having treated this latter disease with ap- 
propriate remedies, the patient was cured of it, and at the same 
time there was noted a suspension of the "Mal de S. Ldzaro," the 
reabsorption of the obstinate tubercules and the general aspect of 
the patient differed from the rest. This patient remained in a satis- 
factory state for eighteen months, and died at the end of that time 
in consequence of an attack of pleuro-pneumonia. 
(Signed.) Dr. JOAQUIN M. GOMEZ, 
In charge of the Lazar Department of the Juarez Hospital. 
Mexico, April 27th, 1885. 
MEXICO. 
FROM THE SUPERIOR COUNCIL OF HEALTH, MEXICO. 
[Received February 14th, 1866. 
1.-Leprosy lias been known in Mexico from very remote times, 
and it exists in the present day. 
a.-There are three different forms of leprosy in Mexico known 
under the following names: the macular form, the tuberculosa, and 
the anaesthetic; and even the common people distinguish them by 182 
giving the name of leoninos to the tuberculous, antoninos to the 
anaesthetic and lazarinos to the macular form, using, at times, the 
last to designate the three forms. 
b.-In the opinion of the Council they are varieties of one morbid 
state, although the symptoms, defining them, differ to such an extent 
that a superficial observer, or one who has not seen a large number of 
cases, might consider them as distinctive forms of one morbid entity, 
if not as entirely different diseases. 
c.-Elephantiasis tuberculosoi is characterized by the presence of 
tubercules in the skin of the face, of the arms and the legs, es- 
pecially in the trunk. These tubercules are sometimes found ulcer- 
ated in a special manner. 
Elephantiasis anvesthetica is characterized by the lack of sensibility, 
more or less complete, of the extremities of the members, and more 
than all by the elimination of the proportions of the necrosed bones, 
or by the re-absorbtion of the bony tissue in these same extremities, 
by the atrophy of the muscles of the thenar and hypothenar 
eminences, and by the re-absorbtion of • the lower tarsi of 
the eyes. The insensibility although most strongly marked in this 
form, is not exclusive to it. 
The macular form has for its special characteristic the presence of 
red and painful macuhe in the legs and arms, exceptionally in the 
face and very rarely in the trunk ; these macuhe resolve or ulcerate 
leaving then peculiar cicatrices. 
2.-According to our observations the age at which it manifests 
itself is from eleven to twenty-five years. The earliest symptoms 
are different in each of the forms in which the sickness is seen ; thus 
in the macular form in the earliest beginning of the disease, when 
even not defined, there is generally a suppression of sweat, numb- 
ness and formication in the hands and feet, which in a little time 
spreads to the rest of the members, which symptoms precede the 
anaesthesia which becomes more or less complete although the 
amesthesia is analgesia, because the sensibility of touch although im- 
perfect is conserved throughout the whole sickness. Afterwards 
follows the falling out of the eyebrows, eyelids, and the hair of the 
arms and body, and extremely rarely that of the head; there pre- 
sents itself also the drying up of the nasal mucous and obstruction 
of the nose. Generally the suspension of the sweat, the insens- 
ibility in the members, the drying up and obstruction of the nasal 
fossa* are the early symptoms of this form which becomes marked in 
two oi' three years by the appearance of maculae, 183 
In the tuberculous form the same symptoms present themselves 
as in the former. Suppression of sweat, amesthesia although not 
marked as in the macular form, the dropping out of the eyebrows 
and of the soft hair, although the dropping of the former is not so 
complete, some hair always being preserved in the inner side of these, 
and it appears that the falling out is in proportion to the number of 
tubercules which make their appearance; on the breast of the 
tuberculous there may be found soft hair, on that of the macular 
form, never. After a longer or shorter period appear the character- 
istic tubercules ; by mere sight these cannot be recognized ; but if 
the hand is passed over the skin where they are about to appear, the 
inequalities presented are noticed; they are liable to appear, some- 
times on the lower or upper limbs, and at other times on the 
face, where they are constant when the disease is in its complete 
development; in this last case they commence by the eyebrows 
(when fallen) and by the lobe of the ears, its volume varying from 
the size of a pin's head to that of a bean. 
In the anaesthetic form is presented the lack of sweat with the 
same conditions as in the preceding forms ; but the sensibility 
(analgesia) reaches a maximum at such a degree that very rarely 
some of the diseased are noted as having burned scars caused by 
placing the members to the fire and sometimes so intense, 
that the cellalur tissue and the muscles, and the inflammation 
developed are found carbonized, which from the burn causes an in- 
tense pain in the persons who have not felt the action of the fire. 
In this form there is no alopesia, there is no deformity in the features ; 
but there are two notable symptoms, the fissures in the soles of the 
feet, which appear very early and great white maculae, true discolor- 
ations of the skin, of the trunk, arms and .head, which when it 
shows have a tendency to spread, the skin in its neighborhood as- 
sumes a roseate color which is not seen when they are stationary. 
3.-The period of life when the disease generally appears is at 
puberty, although exceptionally it presents itself in childhood. In 
the macular form the duration is very variable but as a rule ranges 
from six to eight years, rarely more. The tuberculous continues 
from fourteen to twenty years, and the anaesthetic up to thirty years. 
Death is the usual end of these three forms, and supervened 
through the lesions caused by them or by the complicatians to be 
hereafter spoken of. 
4.-In regard to the sex there is no difference in frequency 184 
with which the disease appears, since in the hospital there is almost 
always an equal number of men and women. 
5.-The black race is not scattered through Mexico where the 
hybrid and pure indigenous races predominate; in them leprosy is 
most frequent, but the whites are not exempt. 
6.-In Mexico it prevails among the poor. Among the causes of 
the disease we ought to count in the first place, heredity, then 
comes the action of moisture; dwelling in the damp places, 
the repeated action of the water on the body appears to favor 
the development, thus, almost all of the diseased have noticed the 
first symptoms of the disease appear after a heavy rain ; but we be- 
lieve that perhaps it is necessary to have a certain condition of cli- 
mate which makes the action more energetic, because in the north of 
this Republic there are cold and damp places in which it may be said 
that the disease scarcely exists at all, and, on the contrary, in the 
south it is much more common where the temperature is much higher, 
therefore we believe that the elevation of the temperature united to 
the moisture of the atmosphere are favorable conditions for the 
development of leprosy. 
7.-The observation of the sick is made in the Capital whence 
they come to be healed principally from places situated at a short 
distance,as Chalco, Santa Arita, Yxtacalco, Mexicalcingo, Ayatha ; the 
most part of these places are low, damp, and situated on the banks 
of streams or lakes; some may be considered as rural and others as 
urban, but subject to malaria. The majority of the inhabitantshave 
their dwellings damp, their laborers consequently are in a bad hygi- 
enic condition, badly clothed and badly fed, and most parts of this 
Republic in which the malady has been observed, as dominant, are 
found to possess analagous circumstances. 
8.-Generally up to the very last moment the disease becomes 
more aggravated, the malady is also developed by a neglect of the 
hygienic methods, and the influence of this is such that the diseased 
who leave the hospitals much improved in health return after a few 
days much worse, without this aggravation can be possibly attributed 
to the natural course of the disease, it is due to the derangement of 
their habits. It is probable that alcoholic excesses contribute to the 
aggravation of the malady. 
9.-The malady is frequently hereditary, the influence of the 
maternal hereditariness being more notable than that of the 
paternal. We do not know any family where one member only has 185 
been affected while all the other members remained free, bnt we 
have known families in which some have been attacked and others 
not. 
10.-There is no reason to believe so, in substantiation it might be 
said that there have been cases in which syphilis has attacked lepers, 
and followed its regular advance without interfering with the leprosy 
which has continued its ordinary advance after syphilis has been 
cured. 
11.-Up to date we have no proof that the disease is commun- 
icated by direct contact between healthy persons with the diseased, 
nor to those who come in close proximity with them. Not one of the 
cases that have been observed would incline one to believe that 
it is transmissible by sexual intercourse. 
12.-To-day persons afflicted with the disease are permitted to 
communicate freely with the people without any restriction what- 
ever, but in very early times they were segregated in a special 
hospital. 
1G.-Anciently, there Was in this city a hospital exclusively ded- 
icated to lepers, but it has been suppressed altogether for more than 
twenty years. Since that time a special department has been in- 
stituted in the Juarez Hospital, consisting of twenty beds for men 
and as many for women; but in other hospitals there are several 
afflicted with this disease who are scattered around without any law 
interfering with them. 
16.-Benevolence maintains those who are treated in the Juarez 
Hospital, and also those who are found scattered around in the other 
Hospitals, and there is no fixed number, for all who apply are ad- 
mitted. 
15.-The malady has existed in Mexico from a period anterior 
to the conquest by Fernando Cortes, and the Conqueror believed it 
to be necessary to establish a hospital especially for lepers ; but in 
the seventy-five years that we have been independent, we believe the 
number of lepers has decreased, because the public necessities are 
amply covered by the before mentioned department of the Juarez 
Hospital, and in the case of the few sick in the other hospitals, not- 
withstanding the daily increase in the general population. As re- 
gards the causes which have produced this dimenution of the 
disease we are unable to designate them. 
16.-We do not know of an instance of a spontaneous cure of the 
malady, in the absolute meaning of the word. 186 
A substantial and strengthening food, composed principally of 
flesh, farinaceous food, and milk as a dietetic regimen, has given 
good results; where the lepers have been treated in a moderate tem- 
perature, in dwellings with a good location, well ventilated and dry, 
a noticeable improvement has been observed. 
In the medical treatment there has been employed success- 
ively and without result, mercurials, hidrocotila sciatica, guano, 
yodadurados, arsenic, sarsaparilla, and tarantula as diaphoretic 
measures. 
In the civil practice of Dis. Liciaga and Reyes it Was observed 
that in the first four cases in which very good results Mere obtained, 
the oil from the seeds of the gynocardia odorata dialmogva was 
used internally and externally, and in other four cases a notable 
improvement Mas obtained by the use of the fluid extract of rhus 
bit uni i nos us m idioacane nse. 
In one of the cases it was noticed that eight years after the treat- 
ment not one of the symptoms of the disease had returned. 
17.-No census has been taken recently; the population is esti- 
mated at 350,000 inhabitants. 
18.-There exists a general and uniform register of births and 
deaths, together with the causes of death from the year 1866 
to date. 
19.-We have not sufficient data to reply to this question with ex- 
actness, but there are some small populations in the east and south- 
west of the Republic where the disease, it is noted, presents itself 
with greater frequency. 
NETHERLANDS AND COLONIES. 
DR. VAN DEVENTER, AMSTERDAM. DIRECTOR OF THE SUBURBAN 
HOSPITAL. 
Leprosy occurs not only in the Netherlands, but also in the East 
and West Indian Netherlands' possessions.' 
The disease presents itself in the three forms of maculosa, tuber- 
culosa and amesthetiea. 187 
The persons in whom leprosy is observed in the Netherlands, are 
such as have returned from the East or West Indies. I have noticed 
unmistakable symptoms of leprosy on such persons, at times on 
their landing, and at others not until two years afterwards. 
Most of the patients delared that they had never known them- 
selves to have been in contact with sufferers •from leprosy; neither 
did they know what leprosy was, nor had they ever met with lepers 
at all. 
In the East and West Indies leprosy is endemic, but whilst the 
disease is of more frequent occurence in the Moluccas than on the 
Island of Java, it is not epidemic in the latitudes first mentioned, 
the number of sufferers there being always very small. 
At one time when leprosy was held to be infectious, persons 
afflicted with the disease, both in the Netherlands and the Colonies, 
were isolated either in special institutions or even on certain islands 
dedicated for that purpose. 
Now-a-days such isolation has ceased to exist, no restriction being 
put upon the leper's liberty. 
The old leper houses in the Netherlands have long since been con- 
verted into hospitals for chronic diseases, but in the pauper Colonies 
of Ommerschaus and Vrenhuisen there is a shed or special ward af- 
fording accomodation for twelve persons: though as a rule no more 
than six beds are occupied. This establishment dates from the year 
18G7, when in a casual way some lepers were discovered among the 
returned and pensioned soldiers from India in Brombeck Asylum. 
These were transferred to the new establishment in which they were 
all treated separately. 
In the few Indian Islands set apart for the treatment of lepers, 
and still open to persons so afflicted if they choose, the sufferers are 
living together. These lepers produce perfectly healthy children, 
out of whom are sometimes born leprous infants. This 
proves the hereditary tendency of leprosy-at least in the form of 
atavism. 
Since the lepers are no longer compelled to live in isolation, one 
does not notice any dread of contagion among the native population 
of the Indies; the people move amidst them as if they were healthy 
persons. 
Only in cases of lepra mutilans is the patient avoided on account 
of his unsightly appearance. In the Netherlands persons attacked 
with leprosy are admitted to the common hospitals, where they are 
ranged by the side of other patients. 188 
Not one case of contagion has ever been recorded. 
Leprosy shows itself among children as well as among adults. In 
the Indies the disease may last for five years-then it ends fatally. 
In the Netherlands it continues much longer, up to fifteen years. 
Leprosy is found equally amongst Europeans, Chinese, Arabs and 
native Indians; it is more prevalent on the seaboards than in the 
mountain ranges. In some families though both parents were pure 
Europeans, and had never been in India before, one of many chil- 
dren was seized with leprosy without any assignable cause for the 
phenomenon. 
It cannot be proved that leprosy is in any correlation with such 
other diseases as syphilis, framboesia, etc. 
The therapeutic as well as the *dipterocarpic methods of treating 
the disease, have been hitherto ineffectual. 
In the case of a child, Dr. Van der Star, privat-docent in 
dermatology, saw a case of leprosy yield, but atrophy of the skin 
and stenosis of the mouth set in. On other parts of the body the 
blotches dissappeared, but atrophy of the skin remained. 
■ The causes of death from leprosy are exhaustion, tuberculosis, 
diabetes, enteritis and others. 
♦DipterocarpuB (Bot). A genus of trees found in the East Indies, which 
afford an abundance of resinous juices. 
THE NETHERLAND'S COLONIES. 
THE MINISTER FOR THE COLONIES, GRAVfiNHAGE. 
In response to the request contained in your letter of May 16th, 
paragraph No 45 w., I have the honor to communicate to Your Ex- 
cellency the following answer to the enquiries of the Consul for 
Hawaii at Amsterdam, in his letter of May 13th, E. C. No. 22., con- 
cerning the occurrence of leprosy in the Netherland's Colonies. 
1.-To what extent does leprosy prevail in the Netherlands and its 
Colonial possessions? Complete information cannot be given because 
it is only the number of patients in the hospitals that is known. It 189 
may however be stated that the disease appears in all parts of the 
Indian Archipelago except the little Sunda Islands, and the northern 
part of Celebes, also in Surinam and Curacao. 
2.-Previous to 1865 there were in the Netherlands East Indies, 
local and provincial regulations enforcing separation for lepers. In 
1868 however, because it was thought to be proved after long exper- 
ience, that leprosy must be considered to be not contagious, it was 
determined on the part of the Government that there was no reason 
for forcing the lepers to separate themselves in the hospitals, or 
dwell in restricted places. In Surinam the matter is regulated by 
the Ordinance of 1830, (Government paper No. 13) modified by the 
Ordinances of 1831, (Goverenment paper No. 12), 1834 (Govern- 
ment paper No. 13 ), and 1853 (Government paper No. 2) ; in Cur- 
acao by the Proclamation of 1830, No. 148 and 1864, No. 7. 
3.-In the East Indies separation of lepers is not enforced, (com- 
pare the second question). In the West Indies, where the disease is 
considered to be contagious, separation is carefully enforced. Persons 
suspected of this disease who go among the public are arrested by 
the police and thereupon examined by a special Medical Commit- 
tee. If they are found to be infected they are sent to the establish- 
ment set apart for the purpose. In the Colony of Curacao they go a 
step further than in Surinam, by removing infected persons to 
the Asylum, even if they have not gone among the public. 
4.-In the East Indies there yet existed in 1865 fourteen Asylums 
for lepers, but in consequence of the regulation of that year, eight 
of them were gradually abolished. The six which still exist serve 
for voluntary Asylums for lepers. In Surinam there exists one 
Asylum for lepers, in Curacao three. The annexed table gives a 
list of the Asylums with a statement of the number of patients, and 
of the manner in which they are supported. 
5.-As has been said above, they think in the East Indies that 
leprosy is not contagious, and in the West Indies that it is. The 
natives in the Netherlands Indies are indifferent in regard to the 
disease. 
Copies of the Surinam Government Papers, and the Curacao 
Proclamations, referred to above, are enclosed. 
The Minister for the Colonies. 
( Signed.) SPRENGER VAN EYK. 
To Uis Excellency The Minister of Foreign Affairs, 190 
ASYLUMS FOR LEPERS (VOLUNTARY) IN NETHERLANDS EAST INDIA. 
ASYLUMS AT. 
Number of 
Lepers at 
the end of 
the year 
1883. 
The Expenses are Paid by 
Pelantoengan (Samarang) 
Lowano (l)johjokarta) 
Wangkoeng (Soerakarta) 
Benkoelen 
Kemang Pampang(Palembang) 
Tandjong Pinang (Riouro) 
36 
39 
65 
12 
22 
15 
'rhe Government. 
Contributions of prominent per- 
sons of Java. 
Idem. 
The Government. 
Idem. 
By Chinamen. The servants are 
Total 
189 
MJ W1V 
ASYLUMS FOR LEPERS IN NETHERLANDS WE 
ST INDIA. 
ASYLUM. 
Number Expenses are 
of Lepers Paid by 
remarks. 
Establishment 'Batavia" on 
the Coppename (river in 
Surinam). 
On the Island Curacao. 
" " St Martin. 
" " St. Eustatius. 
The Govern- 
ment. 
102f 
13$ Idem. 
10$ Idem. 
19$ Idem. 
fAttheend of 1883 
there were 37 Europ- 
ean lepers.56 natives 
and 9 immigrants 
from British India. 
$At the end of 1884. 191 
NORWAY. 
FROM SOREN CASPERSEN ESQ., CONSUL GENERAL FOR SALVADOR, 
CHRISTIANIA, NORWAY. 
.-Yes. 
a.-There are two different forms of leprosy known by the names 
of glat spedalskhed (glet smooth spedalskhed leprosy-Elephant- 
iasis lavis and knuded spedalskhed knuded, Knotty, Cunyry)- 
Elephantiasis tuberculosa. 
b.-These two forms are varieties of the same disease and are 
often found in the same person, the disease beginning with one form 
and afterwards developing to the other. 
c. 1-E. lavis-;spots (macula?) of various sizes and shapes, of a 
reddish-purple color and often combined with the loss of feeling 
(amesthesia). 
c. 2-E. tuberculosa, knots or lumps (tubercula) of the 
size of a pea to a Spanish nut, sometimes spread over various parts 
of the body, sometimes confluent to larger masses, especially in the 
eyebrow and other parts of the face, 
2.-The disease generally manifests itself in the mature age, but 
appears also in children. The earliest symptom are usually a change 
in the person's temper and mind, a change in the features of the face 
and then the appearance of maculae or tubercula. 
3.-The disease attains its full development in the mature age. 
The following table shows the age of deceased lepers in Norway 
in 1880: 
Age of the deceased. 
Men. 
Women. 
Both sexes together 
11 
to 
15 Years old 
1 
1 
15 
to 
20 - " 
4 
6 
21 
to 
30 " " 
17 
8 
25 
31 
to 
40 " " 
16 
10 
26 
41 
to 
50 " " 
24 
8 
32 
51 
to 
60 " " 
19 
9 
28 
61 
to 
70 " " 
8 
7 
15 
71 
to 
80 " - " 
4 
5 
9 
81 
to 
90 •• " 
2 
2 
91 
to 
100 " " 
1 
1 
- 
- 
4.-No. 
5.-There is no colored population in Norway. 192 
6.-Nearly only amongst the poorer classes. 
a.-The disease appears only along the sea coast and its immedi- 
ate neighborhood. The district is mostly hilly, rocky and dry, malaria 
is not known in Norway. 
b.-The sanitary conditions of the dwellings are as a rule good. 
c.-The personal cleanliness is not always as good as it ought 
to be. 
d.-The ordinary diet is fish, often salt or dried, but seldom or 
never rotten, potatoes and porridge, prepared of barley-meal and 
water. 
e.-Fishermen, sailors and small farmers. 
7.-Drunkenness and want aggravate the disease. 
8.-The disease is very often hereditary. Yes. 
9.-No. 
10.-No. 
11.-Yes. The only restriction is that, when lepers are so poor, 
that they want public support, they are obliged to seek it in public 
asylums, and are not supported in their homes in the parishes as 
other poor. 
12.-There are public asylums where all lepers that seek admit- 
tance are received free; in these asylums marriage of course is pro- 
hibited, and the two sexes kept apart. Lepers are also admitted 
into general hospitals, but then only when suffering from other 
diseases. 
13.-In 1880, G17 in public asylums. 
14.-The disease is diminishing yearly. The higher civilization, 
better sanitary habits, and the public asylums, contribute to the 
diminution. 
The known number of lepers was in 1856 2,113. 
" " " 1860 2,068. 
" " " 1870 2,055. 
" " " 1880 1,606. 
15.-In 1880 of the 617 lepers in the public asylums seven 
recovered. From 1857 to 1879 one hundred and two are known to 
have recovered. 
16.-1,851,438. The last census was taken the 31st of December, 
1875, for the provinces: in Christiania every year. 
There is a general registration of births and deaths, including the 
cause of death. Such a registration has been kept for centuries. 
Births and deaths by the parish clergyman, the causes of death by 
the physicians. 193 
17.-The [following table shows the distribution of lepers in the 
provinces in Norway the 31st of December, 1880, and the popula- 
tion of the provinces: 
Provinces. 
Population 
Men. 
Women. 
Both sexes 
City of Christiania 
119,407* 
Smalenems 
107,804 
Akershus 
97,550 
1 
1 
Buskernds 
102.186 
Jarslberg and Laurvigs 
87,506 
1 
1 
Hedemarkens 
120.618 
3 
3 
6 
Christians 
115,814 
83,171 
3 
2 
5 
Bratsbergs 
Nedenos 
73,415 
Lister and Mandals 
75,121 
4 
1 
5 
Stavanger 
110,965 
49 
40 
89 
South Burzentrus 
114,560 
74 
90 
164 
City of Berym 
38,573 
11 
11 
22 
North Burzentrus 
86.208 
117,220 
• 117 
100 
217 
Bomsdals 
82 
- 55 
137 
South Throndhjems 
116.804 
58 
42 
100 
North Throndhjems 
82.271 
51 
35 
86 
Nordlands 
104,151 
79 
50 
129 
Tromso 
54,019 
13 
14 
27 
Trumarkens 
24,075 
545 
444 
989 
In the public asylums 
617 
In the Kingdom of Norway.... 
1,851,438 
1606 
*The population is in Christiania from 
the census of 1880. 
From the 
provinces 1875. 
,- 
- 
SIAM. 
FROM A. KURTZHALSS ESQ., HIS HAWAIIAN MAJESTY'S CONSUL AT 
BANGKOK. 
To Uis Excellency Walter M. Gibson, 
Minister of Foreign Affairs, Honolulu. 
Your Excellency: Since my most respectful letter of the 15th 
of September, 1884, I have had the honor to receive Your Excel- 
lency's despatch of the 28th of December, 1884, referring to leprosy 
in Siam to which I beg to to reply as follows; 194 
I.have consulted with the first medical European and the first 
medical Siamese doctor of the place, and their information concurs 
with the result of my own experience of many years residence 
here, namely: 
1.-Leprosy prevails but very slightly in Siam, more so amongst 
the Chinese than Siamese population. 
2.-It has not yet been the subject of special legislation in Siam. 
3.-The Government of Siam does not enforce segregation of 
lepers, but there exist certain temples here, the priests of which 
specially devote themselves to attending to paupers and lepers by 
supplying them with food and allowing them to camp on the prem- 
ises of the temple. 
4.- No royal or private hospitals or asylums for lepers exist in 
Siam as far as my informants and myself are aware of. 
5.-The prevalent popular opinion as to the contagiousness of 
leprosy is, that the disease is not catching. I have many times seen 
families sitting together or people crowded in a public gambling or 
other house amongst whom was a leper, and no notice was taken of 
him. The Siamese as well as the Chinese assert that the disease is 
hereditary but not catching, and are therefore not afraid of being 
near a leper. 
1 have the honor to be Your Excellency's most obedient servant, 
(Signed.) A. KURTZHALSS, 
Consul. 
SPAIN. 
REPLIES TO INTERROGATORIES REGARDING LEPROSY, GIVEN BY THE 
FACULTY OF THE HOSPITAL OF THE HOLY CROSS 
OF BARCELONA. 
The Faculty of this Hospital to whom was handed the collection 
of questions presented through you in order that they might form- 
ulate their opinion and consider the replies which they ought to give 
to the formulated questions, have discharged their duty in the fol- 
lowing manner: 195 
This Faculty having carefully studied the collection of questions 
regarding leprosy, opportunely forwarded through this Honorable 
Department at the request of the Consulate General of Hawaii in 
Spain, before replying to any of the questions which are therein 
framed, believe it to be a duty to inform the Honorable Administra- 
tion that the actual rarity in Barcelona of the disease which appears 
destined to disappear from the people with the advance of civiliza- 
tion, and the assiduous cultivation and perfecting of the practices of 
hygiene, prevents this faculty from replying to all the questions pro- 
pounded as they desired. The scant number of cases which they are en- 
abled to observe in the Hospital of Saint Lazarus, devoted to lepers, 
as well as in private practice, the endemic form in which the same 
present themselves, are circumstances which make impossible the 
formation of a complete and exact judgment to practically elucidate 
certain questions relating to the epidemic and invading forms of this 
malady which in Spain, fortunately, we have had no occasion to 
watch. 
1.-a. Leprosy is rare in Barcelona and in Spain, and generally 
presents itself endemically, and generally in the tuberculous form. 
One of the subscribers has seen in his private practice, one case 
alone, of leprosy of the anaesthetic form. To judge of the rarity of 
this disease it should be noted that in this Hospital of S. Lazarus, 
designed for lepers, there are in the whole year from four to ten ad- 
missions, some of them repeat the entries for the same sickness, and 
consisting for the most part of cases of Elephantiasis of the extrem- 
ities, (Elephantiasis of the Arabs) accompanied by elephantinacial 
ulcers, that ought not to be considered as cases of leprosy. 
2.-a. In reference to age they have presented themselves from 
twenty to forty years. 
2.-a. From the few cases noticed it would appear to affect in 
greater proportion males than females. 
10.-a. Have been unable to observe any case of contagion, but it 
must be taken into account that the malady has not presented itself 
under any other form than the endemic. 
11.-a. For the preceding considerations communication between 
lepers and healthy persons is not restricted in Spain. 
12.-a. The hospital which in Barcelona is designed for lepers, 
contains two wards exclusively; one for men and the other for 
women, entirely independent, having besides several accessory de- 
partments (refectory, kitchen, dwellings for employees, wardrobes, 196 
offices, etc.) and forms a branch of the Hospital General of the Holy 
Cross. It has for attendance on the sick a Sister, one male and two 
female nurses, and the medical assistance is under the charge of the 
supernumary physicians of the Hospital of the Holy Cross who take 
it by monthly turns. 
13.-a. It is difficult to be able to exactly compute the number of 
lepers in Barcelona, it is safe to say they are very scarce. At the 
Hospital, from one to three a year present themselves. 
15.-a. A great number of medicines have been tried to combat 
this disease, but in almost all cases without result, except that the 
iodic treatment, internally and externally, appears to have given 
some result; but as this affection always presents itself in light 
forms, the patients are allowed to come and go from the Hospital 
without an opportunity being afforded for the completion of observ- 
ations. At any rate it ought to be stated that of the number of 
deaths that have taken place in the Hospital of St. Lazarus, there 
have not been any resulting from leprosy but from intervening 
diseases. 
The patients are afforded a good hygienic and dietie regimen, and 
allowed to be up all the day and walk about, are kept in perfect 
cleanliness of body, and supplied with healthy food and of good 
quality, without making any predilections in regard to special nutri- 
tious aliments whose use is permitted under the authorization of the 
Faculty. This is about all that has been observed with the small 
number of lepers. It may be stated that this Faculty regarding 
this collection of questions propounded by the Consul General of 
Hawaii, and in their answers thereto have held to the practical char- 
acter of the questions, and avoided entirely any scientific digression 
on the said subject. 
By resolution of the Faculty this is addressed to your honorable 
department as the result of their deliberation. 
I have the honor to present it to you, with the sincerest hope, that 
it may be of some use in connection with the humane intentions which 
animate the Hawaiian Government. God preserve you for many 
years. 
(Signed.) JUAN COLL y PUJOL, 
The Administrator in charge. 
Barcelona, September 12th, 1885. 197 
UNITED STATES OF AMERICA, 
REPORT OF THE AMERICAN DERMATOLOGICAL ASSOCIATION. 
In the transactions of the American Dermatological Association 
for 1883, a report by Drs. Fox and Graham is given which embodies 
the results of their combined investigations. The following ten 
propositions were submitted by them as their deductions from the 
facts observed: 
1.-Leprosy is a constitutional disease, and in certain cases ap- 
pears to be hereditary. 
2.-It is undoubtedly contagious by inoculation. 
3.-There is no reason for believing that it is transmitted in any 
other way. 
4.-Under certain conditions a person may have leprosy and 
run no risk of transmitting the disease to other of the same house- 
hold or community. 
5.-It is not so liable to be transmitted to others as is syphilis 
in its early stages. There is no relation between the two diseases. 
6.-Leprosy is usually a fatal disease, its average duration being 
from ten to fifteen years. 
7.-In rare instances there is a tendency to recover after the 
disease has existed for many years. 
8.-There is no valid ground for pronouncing the disease in- 
curable. 
9.-Judicious treatment usually improves the condition of the 
patient, and often causes a disappearance of the symptoms. 
10.-There is ground for the hope that an improved method of 
treatment will in time effect the cure of leprosy, or at least, that it 
will arrest and control the disease. 198 
IOWA, ILLINOIS, MINNESOTA, 
WISCONSIN. 
EXTRACT FROM REPORT OF THE STATE BOARD OF HEALTH OF IOWA ON 
LEPROSY; J. F. KENNEDY, M. D., DES MOINES, 
SECRETARY. 1885. 
In March, 1883, a letter from Dr. F. Eklund. Stockholm, Sweden, 
was received at the office of the State Board of Health, making in- 
quiry as to the number of lepers in Iowa. This was the first intima- 
tion that the disease existed in the State. 
An investigation was made resulting as explained in the following 
correspondence: 
Decorah, Iowa, August 29th, 1883. 
Dr. R. F. Farquharson, Des Moines, Iowa. 
t Dear Doctor:-Your letter to Dr. Bulis regarding leprosy in this 
country was referred to me for action, and in reply will say: I in- 
terviewed all the prominent Norwegians living in our city, and who 
are thoroughly acquainted through the whole county, also having 
been in the practice of medicine in this and adjoining counties for 
twenty-seven years, but had never heard of a case of leprosy. Not 
being able to get any definite information I was about giving up the 
inquiry when the thought struck me to see our County Auditor, Mr. 
Egge, a Norwegian, and he informed me, when he was a small boy, 
one day Dr. J. A. Holmboeck and Rev. Wm. Koren, from Bergen, 
Norway, dined at his father's house. Dr. Holmboeck was looking 
up cases at that time, and they were talking about it. Thus getting a 
clue, I drove out to the house of Mr. Koren and gathered the follow- 
ing information from him: 
He stated that in the year 1863 Dr. Holmboeck visited this 
country and made an inspection through it regarding leprosy among 
the Norwegians. Both gentlemen were familiar with the disease in 
Bergen, Norway, a hospital having been erected there two hundred 
years ago. The doctor asked Mr. Koren for information, and Johan- 
nes Simonsen was pointed out to him. Simonsen was then living on 
East Prairie, but is now living in Military township, two miles north 
of Ossian. Both gentlemen knew him in Norway. (This is Hoelm- 199 
boe's second case). He is seventy-live years old, comes from a 
leprous family, but he has never had any symptoms of leprosy, nor 
any of his family.* 
The Doctor witnessed the death by leprosy of one man twenty 
years ago, and he is thought to have been Knud Ericksen, the party 
you mentioned as living in Locust Lane. 
Mr. Dale, of Madison township, was also from a leprous family, 
but it never developed in his case, nor any of his family. He died 
a number of years ago. 
Mr. Koren further stated that he had had a case in his congrega- 
tion-a certain N. N. Romme-who died April 6, 1877. He had 
lived in this country fourteen years before the disease made its ap_ 
pearance. He was a horse doctor, camped out, and lived on poor 
food. None of his family, however, have been affected. 
I saw another case, said Mr. Koren, and think that it was 
the same one that Dr. Holmboeck saw die twenty years ago. 
The Rev. gentleman further stated that for thirty years he has 
traveled all of northern Iowa and southern Minnesota, and with 
three exceptions, he has never seen nor heard of another case, and it 
is his opinion, as it is also mine, that there is not a single case of the 
disease in northern Iowa or southern Minnesota. 
Respectfully yours, 
R. Small, M. D. 
Health Officer, Decorah. 
Des Moines, Ausust 31, 1883. 
F. Eklund, M. I),, 8 Sheppeholm, Stockholm, Sweden. 
Dear Sir:-Your kind favor of the 31st ult. came duly to hand, 
and you will please accept my sincere thanks for the information 
afforded. Following the clew given in your letter, I have invest- 
igated the matter, and with the foilowing result: 
In 1863, the time of the visit of Dr. A. J. Holmboeck, the Rev. 
Mr. Koren, was the Norwegian clergyman in Winneshiek county, 
and from him the following was learned : 
1. Johannes Simonsen in 1863 lived on East Prairie, and was 
pointed out to Dr. Holmboeck by the Rev. Mr. Koren, as of a leprous 
♦There is some error here, for Dr. Helmboe knew leprosy well, and could 
not have been mistaken; neither could the patient recover-such an event 
being unknown. The mistake arises from the custom among the Scand- 
inavians of transposing and repeating both Christian and surnames. 200 
family; however, he has never yet had the disease, but is alive now, 
75 years old, and in good health. 
2. According to Mr. Koren, Dr. Holmboeck witnessed the death 
of a man by leprosy twenty years ago, and he thinks it was Knud 
Ericksen, of Locust Lane. 
3. The case of Ljar Peterson cannot be traced. 
4. Kev. Mr. Koren further stated that he had a case in his con- 
gregation, a certain N. N. Romme, who died April 6, 1877. He had 
lived in this country fourteen years before the disease had made its 
appearance. He was a horse doctor, camped out and lived on poor 
food. None of his family, however, had been affected. 
The Reverend gentleman further stated that for thirty years he 
has traveled all of Northern Iowa and Southern Minnesota, and with 
these exceptions, he has neither seen nor heard of any other case, 
and it is his opinion that there is not a single case of the disease in 
Northern Iowa, or Southern Minnesota, and this opinion is endorsed 
by Dr. Small, Health Officer, Decorah, a medical practioner of 27 
years. Yours truly, 
R. J. Farquharson, 
Secretary. 
Dr. R. J. Farquharson, 
Secretary State Board of Health, Des Moines. 
With the post of yesterday I have got in good order the valuable 
information that you have brought together and sent me concerning 
the fates of my poor leprous countrymen and brothers. A copy of 
your esteemed paper I send with the same mail to the honored 
society of Norwegian physicians for to be inserted in their trans- 
actions. Please accept my humble, sincere thanks. 
With high esteem, your humble, obedient servant, 
Dr. F. Eklund. 
Sweden, Stockholm, 8 Shippeholm, 1883. 
Norway, Minn., July 17, 1883. 
Dr. Chas. N. Hewitt. 
Dear Sir:-In answer to enclosed letter from Dr. Eklund, Stock- 
holm, Sweden, I have to state: Last year I sent a circular to Nor- 
wegian physicians and the Norwegian clergymen in this State, whose 
names I found on the roll of members in the yearly reports of their 
different synods, inquiring about the leprous they knew of, their 
t 201 
number and condition. I got answers from about twenty of the 
persons applied to, living in eleven of the densest populated counties, 
and I have reason to believe that they who did not return any 
answer, omitted to do so, because they did not know of any suffering 
from that kind of disease. 
In the answers received, I got the names of three men supposed 
to be leprous, but to judge from the symptoms described, I would 
take only two to be suffering from the disease, and in the anaesthetic 
form, both natives of Norway. One had it already in the old 
country, but was first seriously attacked seven years after he came 
to this country, i. e. nine years ago. He has grown children, all 
well. The other had a brother who died of leprosy. He had no 
children. The third person named as infected is a native of Temt- 
land, Sweden, but the symptoms described do not support the sup- 
position of leprosy being the disease. 
Besides these two (or three) I knowr of three more cases living in 
my neighborhood, one woman and two men. They have all brought 
the disease with them from the old country. Two of them have 
children, and one also grand-children-all of them are well. 
In the course of the last ten years I have seen some other cases, 
who have applied for treatment, but they did not reside here, and I 
have lost track of them. Some of them belonged to another State, 
and were traveling for work. Within the same time five leprous 
have died in my vicinity, but in one of then (Prof. Wm. Boeck's 
observation No. 2) the disease had stopped years before. They 
were all men, three 'were not married; the other two left large fam- 
ilies and full-grown children ; one also grand-children. All of them 
are, as far as I know, in good health. Of the eighteen leprous Prof. 
Wm. Boeck met with, when he in 1869 and 1870, visited this country, 
four are marked down as living in Minnesota. Two of them (ob- 
servation 2d and 3d ) have since died, while one (observation 1st) 
is living yet. The fourth (observation 13th) I have heard nothing 
from. 
Most likely there are several more leprous in the State than those 
above named, but it is not so easy to get the track of them. The 
population is moving, some few coming in every year mostly from 
the old country, many more going west. Many of those afflicted 
with the disease try to conceal it as far as it is possible. Even if 
they apply to a physician for relief, they will sometimes try to de- 
ceive him in regard to the nature and history of the case. When 202 
questioned about the health of their relatives they will assert that 
they never knew of any leprosy among them ; pressed closer, they 
will remember that an uncle or a brother has died in the leproserie. 
The number of cases would, so it seems, be less every year, and 
the disease soon disappear, were it not for the new importations; the 
generations born ii/this country seem to be exempt. Under present 
circumstances, while the immigration continues with the same 
strength, as in the last generation, there is reason to believe that the 
disease will rather diminish than otherwise. 
The immigration has been going on for about two generations, and 
been considerable in the last, while the disease in the later years, in 
the old country has been better controlled, and is steadily decreas- 
ing. In Norway at the end of 1878, the number of persons suffering 
from this disease was 1,G81, while in 1874 it was 1,832, and in 185G, 
2,113, which figures for the latter dates ought to be made larger yet, 
as the investigation then was not carried on as strictly as in later 
years, and many diseased were overlooked, who have been added to 
the number of the following years. It is then probable that we in 
the future will have fewer cases imported. 
This my dear doctor is, although not much, what I have to remark 
in regard to the occurrence of leprosy in Minnesota, and in answer 
to the letter you transferred to me. 
Very truly yours, 
Chr. Gronvold. 
Norway, September 11, 1883. 
Norway, Minn., September 11, 1884. 
Dr. Chas. Hewitt. 
Dear Sir:-In answer to Dr. Farquharson's inquiries, I have the 
honor to report, that of the eighteen cases Prof. Wm. Boeck, in 
18G9-70, found in the three Northwestern States, 
4 were living in Minnesota, 
3 were living in Iowa, 
2 were living in Illinois, 
9 were living in Wisconsin, if Highland Prairie is there, for one. 
That is all the locality named. 
The 3 cases in Iowa were: 
Anaesthetic form. Boeck.7th observation. Edward Wilson Taraldsg- 
aard, Winneshiek county, Hesper township, was then (18G9), 23 
years old, two years in America; brought the disease with him from 203 
Norway, where he got it nine to ten years before. Had in that 
country leprous relatives. 
2. Mixed form. Boeck, 9th observation. Ole Torkildson Fosse 
is put down as living in Minnesota, Winneshiek county, Pleasant 
township, but as there is no county of that name in Minnesota, he 
belongs most likely to Iowa-then thirty years old ; got the disease 
three and one Half years after the arrival in this country; had in the 
old country leprous relatives. 
3. Anoesthetic form. Boeck, 10th observation. Ole Iverson Dale, 
Winneshiek county, Iowa. Then, in 1869, forty-three years old; 
brought the disease with him from Norway. Does not know of any 
leprous relations. 
These are the three (3) cases I find in Prof. Boeck's report, 
residing in Iowa. But as it is thirteen (13) years ago, they 
may be dead, all of them, or gone West somewhere else. 
Of the four (4) Prof. Boeck found in Minnesota, three are dead 
(I have now traced the third, also), while one, as far as I know, is 
alive yet. 
The report I speak of, and from which I have taken the above, is 
written by Prof. Wm. Boeck, Christiania, Norway, some years after 
having returned from America. 
It is written in the Norwegian language. I have one copy in my 
possession, and shall be happy to give you any information out of it 
that you may wish. 
Dr. Boeck did not believe in contagion, and explains the disease 
as depending upon heredity, in the three cases above, as in the rest 
of the lepers he found here, with the exception of one, "where we 
might think of contagion, as there are found no lepers in the family," 
as was stated; but then he adds: "All that we have observed in 
our country has, so far, kept that (contagion) away from our 
thoughts, but I am not, therefore, blind to facts. Although the ex- 
perience on the Sandwich Islands, Madagascar, and other places, 
seems to demonstrate the contagiousness of the disease, scientifically 
speaking, and practically too in many places, specially in tropical 
seashores and islands, there seems in the light of existing facts to be 
very little risk of the disease spreading by contagion in our country, 
and what little risk there may be of contagion, will probably be 
completely removed by regard to the common rules of cleanliness." 
Respectfully yours, 
Chr. Gronvold, 204 
Among the deaths reported from Story county for 1883, was one 
caused by Elephantiasis grcecorum. A request was sent to the at- 
tending physician to furnish a history of the case, to which he 
made the following reply: 
Nevada, Iowa, February 21, 1885. 
L. F. Andrews, Secretary State Board of Health. 
Dear Sih :-In answer to your inquiries regarding a case of 
leprosy in this county, I have ascertained that Ole K. Hill came 
from Olen (pronounced nearly like " Airlen"), District of Bergen, 
Norway, in the year 1866. First located at Des Moines, and soon 
after at Cambridge, in this county. Upon his election as County 
Recorder in 1874, he came to this place, where he remained until 
his death, in 1883. In Norway his occupation was that of a fisher- 
man. Was attacked with the disease about 1873, which he recog- 
nized at once, having been familiar with it in Norway. A sister (I 
think) died of it there many years ago. His was a typical case of 
the tuberculated variety of Elephantiasis groecoruni (lepra tuber- 
culosa elephantiasis') and therefore needs no special description. 
His wife (an American lady) lives at Cambridge, Iowa. His 
father, mother, one brother and two sisters, live in this county 
(farm name-Haug6), and betray no symptoms of the disease. 
Respectfully, 
P. W. Farrar, M. D. 
Thus we have eight cases of leprosy in Iowa in the past twenty 
years, all now' dead, the last dying in August, 1883. 
These cases may be tabulated thus: 
AUTHORITY. 
YEAR. 
COUNTY. 
NO. 
NAME. 
Hoelmboe 
1863 
Winneshiek. 
1 
Ljar Peterson. 
Hoelmboe 
1863 
Winneshiek. 
9 
Johannes Simonssen. 
Hoelmboe 
1863 
Winneshiek. 
3 
Knud Eriksen. 
Koren 
1877 
4 
N. M. Romine. 
Boeck 
1870 
Winneshiek. 
0 
Edward Nielson Taraldsgaard 
Boeck 
1870 
Winneshiek. 
. 6 
Olo Torkinson Fosse. 
Boeck 
1870 
Winneshiek. 
7 
Ole Iverson Dale. 
Farren 
1883 
Story 
8 
Ole K. Hill. 
In 1880 Winneshiek comity had a population of 23,938, of whom 
7,862, were Scandinavians (Swedes and Norwegians) numbering 205 
4,095, or 52 per cent. There were in the whole State 39,145 Scand- 
inavians, so that Winneshiek county contained about ten per cent. 
It may be thought by many that the danger from the spread of 
this disease is slight, but as Dr. Billings remarks: "the danger is no 
doubt small-that is to say there is a very small risk of a very great 
danger-but it exists, and now is the time to guard against it." 
The causes of leprosy are believed by eminent waiters and practi- 
cal observers to be many and different. The modes of propagation 
may be reduced to two, contagious* and hereditary transmission-f 
That it it is contagious, is evidenced by the established fact (Gradle) 
that it has a peculiar bacillus. If not, it is a strange exception to 
its kindred, glanders, tuberculosis, etc. But it is not contagious in 
the usual acceptance of the term. It requires actual inoculation of 
pus or blood into the circulation through open vessels or abraded 
surfaces, and there must then be a favorable cachectic condition to 
the action of the virus. Cohabitation is also a source of infection, 
so also "inhibition of the excreta of lepers."f 
MASSACHUSETTS. 
EXTRACTS FROM THE FOURTH ANNUAL REPORT OF THE STATE BOARD 
OF HEALTH, JULY, 1883. SAMUEL W. ABBOTT, M. D., OF 
WAKEFIELD. 
In December, 1882, a former resident of Salem, who had been ab- 
sent several years from his native city, chiefly at the Sandwich Islands, 
returned to Salem, having contracted leprosy during his absence. 
At the invitation of the local board of health, he was visited by 
members of the State Board, and also by Drs. White and 
Wigglesworth of Boston, who confirmed the diagnosis. 
The statement of the leper, together with that of other persons 
who had known him in former years, showed that he had contracted 
♦Carter, Hillebrand, Wilson, Jones, Helmboe. ^Carter, Boeck, Virchow, 
Danielssen. fLiveing. 206 
the disease while living in Honolulu, and that it had first made its 
appearance upon him several years before he came home. 
On his arrival in Salem in December last, the external marks of 
the disease were very evident. The skin of the face, especially of 
the forehead, the ears, the nose, and eyebrows, the hands and the 
feet, was greatly disfigured with tubercles of variable size. The 
skin of the thighs, the chest and abdomen was mottled and dis- 
colored. The toes were ulcerated and suppurating. The pharynx 
and the soft palate presented an inflamed and tubercular appearance. 
The voice was altered. His eyesight was also dimmed. The sight 
of one eye was gone, and he could only read coarse print with the 
other by means of a strong light. The large nodules were mostly 
devoid of feeling. His general condition was feeble. His appetite 
was impaired. 
He was placed in the Salem almshouse in an isolated apartment, 
and soon after a temporary house was constructed for him outside 
the almshouse, where he remained, gradually failing, until his death 
in the following March. 
Since the disease clearly comes within the meaning of the act re- 
lating to contagious diseases, and since no allusion has thus far been 
made to it in previous reports of this Board, a brief account of its 
history and prevalence may not be deemed out of place at the 
present time. 
History.-The existence of leprosy may be traced backward into 
the remotest ages of written history. From its early existence in 
Egypt and Syria, it may be traced into Persia, Hindostan, Turkey, 
and also into all the countries of Europe. Emigration spread it 
widely from the east to the west, and from the south toward the 
north. 
The return of the Crusaders appears to have played an important 
part in its distribution. In the thirteenth and fourteenth centuries 
there was scarcely a town in which it did not exist; and leper- 
houses were numerous where the order of St. Lazarus devoted their 
lives to the care of the sick. There were at one time nineteen 
thousand such houses in Europe intended for the isolation of 
the sick. 
In all European countries it was the policy of Church and State, 
in the fourteenth and fifteenth centuries, to stamp out the disease. 
Bulls were issued by Popes, and stringent laws were passed as to the 
medical examination, condemnation and status of lepers. The 207 
leper was made legally and politically a dead man. Ilis marriage 
ties were dissolved, the services for the dead was performed over 
him, and he became an outcast. These measures had their effect in 
rapidly lessening the disease; but it has never been entirely erad- 
icated from the nations of the earth. 
In proof of an identity of type, at least for nearly four centuries, 
there is still in existence a painting by Holbein at Munich, dated 
1516, representing a group of lepers. It faithfully portrays a man 
whose face is covered with round, reddish knobs. There are also 
other lepers in the group, in various stages of the disease, whose ex- 
ternal characteristics agree very closely with the modern figures of 
Danielssen and Boeck, and the descriptions of our modern writers. 
Virchow says that these pictures must have been painted from studies 
of actual lepers in a leper-house of the mediaeval period. 
Present Distribution.-Leprosy is endemic at the present day in 
many parts of the inhabited world, under divers conditions as to 
climate, degree of civilization and habits of life. 
It exists chiefly in India, China, the Malay Archipelago, Egypt, 
Palestine, Turkey, the Grecian Islands, the Coast of the Black Sea, 
certain Mediterranean ports, Spain, Portugal, Norway, Russia, Ice- 
land, Scotland, Madeira, the Canaries, New Brunswick, Canada, 
Brazil, Mexico, Central America, Madagascar, Africa, Mauritius, the 
Seychelles, New Zealand, and the Sandwich Islands. It is increasing 
in Crete and the Sandwich Islands. 
This wide distribution in many places where it had no ancient 
history is attributed to the tide of immigration which followed the 
era of Portuguese and Spanish discovery. 
In North America, it is known at New Orleans, at San Francisco, 
Charleston, New Brunswick, and in Scandinavian settlements in the 
North-western States. Twenty cases have been observed at Sacra- 
mento, and several were returned from San Francisco to China by 
the health authorities. 
A peculiar interest attaches to the history of leprosy as existing 
in the Hawaiian Islands, and also at Tracadie in New Brunswick.* 
In consequence of its slow and insidious progress, it is not possible 
to fix the exact date of its first appearance at Hawaii. Its existence 
there may be safely stated as less than half century, and it had 
* Although neither of these localities is within the limits of the United 
States, onr commercial relations with these nations are such as to awaken a 
greater interest in their condition. 208 
made but little progress until within the past twenty-five years. Its 
prevalence is now so general as to threaten the existence of the 
nation, which, from this and other causes, has diminished rapidly 
within the past century of its existence. 
As a proof of national decline, may be adduced the vital statistics 
of the Islands: 
fin 1870 the births were 2,413, and the deaths 3,819. In 1871, 
births, 2559 ; deaths, 3,502. 
Here in a native population of but little over 40,000, we find an 
enormous death-rate, and an excess of deaths over births of 2,349 
in two years, or 47 per cent. 
Leprosy appears to be confined almost exclusively to the native 
population in the Sandwich Islands, a few foreigners only being 
affected. 
United States.-Within the domain of the United States, leprosy 
has not at any point made active progress. The rapid immigration 
of the past two years must, however, introduce into the country a 
greater or less number of persons in the incubative or doubtful stage 
of leprosy. On our Eastern coast, such cases may be looked for 
among the Scandinavian immigrants, especially those from Norway, 
where there are still about two thousand lepers. These people have 
settled chiefly in the Northwestern States, Minnesota alone having 
100,000 Scandinavian settlers. Thus far. however, leprosy does not 
appear to have found a foothold among them, and no persons born in 
the Northwestern settlements have as yet been found to be 
affected. 
Dr. Bendeke of Minneapolis says: " It occurs in much less pro- 
portion here among the emigrants than in Norway; and I ascribe 
this only to the better hygienic situation of the people as to food, 
clothing, exposure, etc." 
On our Western coast, the chief source of the disease is China. 
A leper hospital has been established at San Francisco, and fifty-two 
cases have been admitted in ten years, all of whom with a single ex- 
fA typographical error in the Report of the Board of Health for 1870 
gave eleven hundred deaths too many. This important mistake was dis- 
covered by Dr. Arthur Mouritz while compiling his Report. In regard to 
the numbers quoted it should be stated that in 1870-1871. the Islands were 
visited by a fatal fever. In the year 1872-1873 the deaths were 6,065. and 
the births 4,710, thus reducing the excess of 2,349 deaths over births to 
1,355. 209 
ception were Chinese; and no case has been reported of a native 
citizen of California acquiring leprosy. 
Other foci of the disease have been observed at Charleston, S. C., 
and also in Louisiana. In the former city, Dr. Geddings has ob- 
served sixteen cases in the past thirty-five years, and published a re- 
port of the same in the Transactions of the International Medical 
Congress held at Philadelphia in 1876. 
Occasional cases have also been reported in the Gulf States dur- 
ing the past and present centuries. 
* * * * 
Leprosy has been recognized as early as the third year, but it is 
rarely diagnosticated before the age of puberty, from which time it 
occupies an average period of ten years in attaining its develop- 
ment. In the amesthetic form the effect on the duration of life is 
not so marked as in the tubercular. 
Lepers are very susceptible to the influence of colds, and are often 
affected with pulmonary diseases, erysipelas, nephritis and ascites, 
and succumb easily to a want of proper food. 
Death usually takes place from intractable diarrhoea, or dysentery, 
either acute or chronic. 
Leprosy in its relation to Public Health.-1The questions which ren- 
der leprosy a matter of special interest as affecting public health are 
those of etiology, modes of propagation, and the question of con- 
tagion. 
The causes of leprosy have been sought for in the peculiarities of 
climate, soil, diet and habits of life. As regards climate and soil, 
the wide geographical distribution of the disease would seem to pre- 
clude them as elements or factors of causation. Opinions differ 
much as to the question of diet. The eating of tainted fish has been 
strongly urged as a cause. Leprosy is found in a most aggravated 
form among fish-eating people, as in Norway and Crete, and, on the 
other hand, it also prevails in inland districts where fish is but lit- 
tle used. 
Doubtless an improper diet and bad hygienic surroundings ag- 
gravate the disease. 
All these causes acting together for centuries did not produce the 
disease in the Hawaiian Islands, nor was it known there until some 
time after the islands were open to foreign trade and commerce with 
other nations. Hence it is reasonable to suppose that it was im- 
ported from other places. The first leper in Hawaii was not recog- 210 
nized till 1853. The natives attribute its origin to China, and this 
belief is confirmed by history and observation. 
Inheritance.-There can be but little doubt as to the question of 
inheritance of leprosy. Its decided influence on the disease is 
maintained by nearly all writers on the subject. Hereditary in- 
fluence is universally accepted in China, and intermarriage of lepers 
is there forbidden. On the other hand, it is not safe to accept the 
theory of inheritance as the only mode of propagation. The history 
of the disease in the Sandwich Islands may again be adduced in op- 
position to an exclusive theory of inheritance, since scarcely a single 
generation has elapsed from the time of its appearance in the Isl- 
ands. The theory of inheritance must necessarily require a much 
longer time for its proof. Especially is this true of a disease whose 
incubative stage is measured not by days or months, but 
by years. 
The relation of Leprosy to Syphilis.-The careful study of med- 
ical men has been favorable to the belief that syphilis is a predis- 
posing cause only, and productive of a condition favorable to the 
reception of leprosy in an individual. A recent report of the 
Hawaiian Board of Health contains an article by Dr. Fitch of Hon- 
olulu asserting that leprosy is a fourth stage of syphilis. The 
weight of professional opinion, however, is to the contrary. 
Contagion.-As to the part played by contagion, Dr. White says, 
in his excellent article:* "Heredity as the only, or an important 
factor, is entirely out of the question. It would have required sev- 
eral generations to have accomplished such results. We must look, 
then, to the customs of the race as exceptionally favorable to inoc- 
ulation as the only possible explanation,-such as the crowding to- 
gether of large families in small huts, sharing the same mats and 
blankets, eating poi with the fingers from the same calabash, drink- 
ing of ava from the same vessel, passing the pipe from mouth to 
mouth, their licentious habits, the absence of all fear or disgust of 
the disease as a bar to ordinary association, cohabitation or 
marriage." 
The contagious nature of leprosy, although vehemently denied by 
a few, has certainly been recognized from the earliest ages. In 
proof of this view are the rigid Levitical enactments of the ancient 
Jews; the stringent work of both Church and State, in the four- 
♦"The question of Contagion in Leprosy." Am. Journal of Medical 
Sciences, October, 1882. 211 
teenth and fifteenth centuries, to stamp out the disease by isolation, 
dissolution of marriage ties, and social ostracism; and, in the 
present day, the forcible segregation of lepers from their homes, 
their relatives and their friends, by sanitary legislative action. These 
measures have had a salutary effect wherever they have been intro- 
duced and enforced for a long period of time, and doubtless con- 
tributed to the general disappearance of the disease in the sixteenth 
and seventeenth centuries throughout Europe. 
fin the Hawaiian Islands the disease is made a subject of legisla- 
tion by " An Act to prevent the spread of leprosy." 
As an evidence of the importance of this branch of their duties, 
the Hawaiian Board of Health expended for the execution of the 
Leper Act, and for the support of the Leper Colony, in 1872, the 
sum of $31,000, out of a total of $51,000 for all health expenses. 
In 1874, $55,000 for the Leper Colony. In 1880, $85,000 out of a 
total of $174,500. In 1882, $90,000, out of a total of $237,500. 
Sanitary science has been regarded as new, and in fact, has made 
the most of its progress within the past twenty-five years ; but so far 
as leprosy is concerned, it has existed for centuries. The necessity 
of isolation was recognized and rigorously enforced in the patri- 
archal era, three thousand years since; and wherever the disease 
has invaded and menaced the public safety of a nation, the same 
principle has been recognized in the construction of leper-houses, 
lazerettos, asylums, etc., the enactment of laws requiring isolation, 
the prohibition of intermarriage, and confiscation of property. The 
same principle was recognized in the Middle Ages in Europe, and 
also exists at the present day in a varying degree in all places 
wherever leprosy has gained a foothold. 
A careful consideration of the history of leprosy as now existing 
in two different countries, Norway and the Hawaiian Islands, may 
afford additional light upon the subject of contagion. In the former 
country, in 1856, there were 2,863 known cases of leprosy, of which 
number 235 were in hospitals, and the remainder living in their 
homes. In later years a dimunition of the whole number to 2,704 in 
1866, of which number 795 were in hospitals. In 1876 there were 
2,008 cases, and there has been a regular decrease since that date to 
1,582 cases in 1880, a total decrease of 45 per cent, in twenty-five 
j-See Section of lieport "Leprosy in Hawaii." page 8. 212 
years. JThis result has been attributed in a great measure to more 
careful isolation. 
On the other hand, in Hawaii the disease has rapidly increased 
daring the same period. Although it has not been known in the Isl- 
ands more than forty or fifty years at the most, there are now at 
least 800 lepers, an enormous number when compared with the 
small indigenous population of 40,000. This people appear to have 
been extremely susceptible to the introduction of any infectious 
disease. Syphilis, leprosy and small-pox have made sad havoc 
among them. At least 500 died of small-pox in 1881. 
The excessive death rate already mentioned threatens the life of 
this little nation, which must sooner or later be wiped out of exist- 
ence unless the decimation of the people is arrested. 
If it be urged that isolation and other sanitary measures have not 
succeeded in controlling the spread of leprosy in the Sandwich Isl- 
ands, it should also be stated that in the earlier years of sanitary 
control the execution of the law was opposed very generally, es- 
pecially by concealment and deceit. 
Again a great obstacle to the thorough understanding of the con- 
tagion of leprosy consists in its indefinite and lengthy period of in- 
cubation. The shortest time of development is one year, and it has 
appeared as late as nineteen years after inoculation.* So long a 
range is unknown in the case of any other disease. In small-pox, 
scarlet fever and other diseases, the period of incubation is short, 
decisive and well defined, and hence the active cause is readily 
recognized. But when this period is measured by years instead of 
days, the actual facts and conditions of exposure are apt to be for- 
gotten or denied in toto. 
As a matter of vital importance to the safety of the Hawaiian 
nation, a Board of Health was organized as early as 1865 and in 
accordance with the provisions of the act already cited, a hospital 
for temporary detention and examination of lepers was established- 
JSee Dr. Vandyke Carters's report, "Leprosy in India," page 82. 
*Asan instance illustrating the doctrine of contagion, and also of extremely 
long period of incubation. Dr. Hillebrand narrates a ease in Borneo, 
where a boy of European parentage was accustomed to play with a lep- 
rous child of color. The native boy thrust a knife into the amesthetie part 
of his body, which act was immediately repeated by the white lad with the 
same knife. The latter was soon after sent to Holland, where he grew to 
maturity, and nineteen years later developed the disease, returning to 
Borneo a confirmed leper. 
tReorganized is more correct, as a Board of Health was established 
in 1850. 213 
a sort of probationary station to which all suspected lepers were 
taken and examined, or placed under surveillance until they were 
determined to be either lepers or non-lepers. 
After the establishment of the Kalihi hospital, the next move was 
the purchase of a portion of the Island of Molokai for a colony 
whence all those who had been determined to be lepers at the Kalihi 
hospital should be transferred for a permanent residence. 
There had been examined up to 1872, 1,288 persons, of which 
number 570 were discharged at once, and 145 subsequently; 529 
were sent to Molokai. Deducting loss by death and other causes, 
385 remained March, 31, 1872. 
The number of admissions in the following year appears to have 
greatly increased, for Dr. Trosseau's report states the number in the 
settlement as 800, or 2 per cent, of the entire population. 
The commitments in 1874-187G were 297, and the deaths from 
leprosy 299. 
The entire admissions to Molokai in ten year^ were 1,570, an an- 
nual average of 157. The deaths in the same time were 872. 
The settlement at Molokai is admirably adapted to isolation, which 
is naturally afforded by the topographical character of the place. A 
precipitous wall 2,000 feet in height on the one hand, and the sea on 
the other, render escape almost impossible. 
In some villages among the Islands leprosy appears to be much 
more prevalent than in others. 
Dr. Piffard urges the necessity of a national central lazaretto; the 
confining therein of all lepers now in the country; and the watching 
of immigration, and giving each leprous immigrant the option of re- 
turning to the country whence he came or of entering the lazaretto. 
This will have to be done sooner or later, and the sooner the less 
difficult the undertaking. 
Bacillus.-A bacillus peculiar to leprosy has been discovered, and 
may now be considered as a settled fact, its presence having first 
been asserted by Hansen as early as 1873, and also identified by 
other foreign observers, among whom are Koch, Kobner, Neisser, 
Cornil and Suchard. While its presence has thus been repeatedly 
demonstrated, its position with relation to the inocubility of leprosy 
is a matter far more difficult to determine, for the reason that most 
of the animals commonly employed for the purpose of experiment 
are too short-lived for use with reference to a disease whose incub- 
ative period is of such long or indefinite duration. 214 
Dr. Belfield states: " It is, then, established that a bacillus of 
specific size and shape is a constant element of the diseased tissues 
in tubercular leprosy. Yet this fact of association does not, of 
course, prove that the bacillus causes the morbid process, since it is 
conceivable that it appears as a sequence rather than a cause of the 
disease. This latter conception is certainly not entirely satisfactory. 
It does not plausibly explain why this bacterial variety, and this one 
only, is found, and always found, in the leprous nodules, but in no 
other diseased state." 
SAN FRANCISCO, CALIFORNIA. 
DR. J. L. MEARES, HEALTH OFFICER OF SAN FRANCISCO BOARD OF 
HEALTH, 1884. 
" The isolation of lepers is so important and its necessity so self- 
evident, that I scarcely think the subject worthy of discussion. 
Hitherto the entire expenses of supporting a lazaretto has fallen 
upon the people of San Francisco, and will continue to do so, unless 
the State, as it ought to do, takes in hand this important matter. 
We probably have more than 100,000 Mongolians on this coast, 
and even if the Restriction Act should be efficiently enforced, still 
you have the fact staring you in the face that leprosy will continue to 
develop, as heretofore among the people. 
Those of us familiar with the execution of our sanitary laws, 
know the fact that leprosy is not imported into San Francisco, unless 
a case in its incipiency should escape the careful inspection adopted 
both at Hongkong and the port of San Francisco. 
This disease, like consumption, may lie dormant for years, and 
then develop at any period of life without any apparent exciting 
cause. 
The prejudice of the people against the Chinese has undoubtedly 
confined this disease almost entirely to that race; but as the Restric- 
tion Act will necessarily diminish this population, their labor will be 
more in demand; and when by their industry and desire to learn, 215 
they acquire a more thorough knowledge of our language and become 
more assimilated to our manners and customs, will not this prejudice 
gradually subside? And will it not come to pass, in a few years, 
in this cosmopolitan city, continually being made more so by immi- 
gration from all parts of the world, that marriage between the 
Chinese and people of other nationalities will become a frequent oc- 
currence? Although this disease may not be contagious, in the or- 
dinary acceptation of that term, we are satisfied that it is commun- 
icated by inoculation and by other means not necessary to discuss 
here." 
In the year 1883 action was taken by the Board of Supervisors of 
the City and County of San Francisco, in answer- to the public de- 
mand to cause strict search to be made throughout the Chinese 
quarter and the city, aud all cases of persons found affected with 
leprosy or elephantiasis removed to the lepers' quarters provided. 
In addition to the United States and State legislation, the following 
Order was finally passed and approved on August 14th, 1883, the 
enforcement of which it was supposed would aid in preventing per- 
sons from being landed afflicted with leprosy or elephantiasis, or if 
in the city and county from being secreted or kept in any place other 
than in the lepers' quarters-the intention of the Board, as shown 
by previous deportations, being to send all Mongolian cases back to 
China at the first opportunity. 
The order referred to is as follows: 
order no. 1,738. 
Prohibiting the Landing from any Vessel of Persons afflicted with 
Leprosy or Elephantiasis within the Bay of San Francisco, and 
Providing for the Removal of Persons so afflicted to the 
Lazaretto, 
[Preamble.] 
Whereas, The public welfare demands that some action be taken 
to prevent the landing of persons within the city and county afflicted 
with the disease known as leprosy or elephantiasis, which diseases 
are,- in the judgment of this Board, contagious under certain cir- 
cumstances and conditions; and 
Whereas, In view of the dreadful results of said diseases, every 
means justifiable for the protection and preservation of life should 
be taken by this Board to prevent the free and unrestricted coming 
of persons from foreign ports who are so afflicted; therefore 216 
The People of the City and County of San Francisco do ordain as 
follows: 
[No Leper or person afflicted with Elephantiasis to land from 
any ship or boat.] 
Section 1. No person afflicted with the diseases known as leprosy 
or elephantiasis shall, upon any pretext whatsoever, be permitted to 
land from any vessel or boat upon the shore or within the limits of 
the City and County of San Francisco. 
[Captains, Officers, Owners, Consignees or Agents of Vessels arriv- 
ing to prevent the landing of Lepers from such Vessels.] 
Section 2. No captain or other officer in command of any vessel 
arriving at the port of San Francisco, nor any owner, consignee, 
agent, or other person having charge of such vessel, shall land or 
permit to leave said vessel in this port, any person affiicted with the 
diseases known as leprosy or elephantiasis. 
[Captains or other Persons having control of Vessels arriving, or in 
the Harbor, having Leprosy, etc., on board, to report the same 
to Quarantine Officer within twenty-four hours of the arrival.] 
Section 3. All captains or other officers bringing vessels into the 
harbor of San Francisco, and all masters, owners, or consignees 
having vessels in the harbor which have on board any cases of lep- 
rosy or elephantiasis, shall, within twenty-four hours after the arrival 
of said vessels, report the same in writing to the Quarantine Officer, 
or as soon thereafter as they or either of them become aware of the 
existence of said disease on board of their vessels ; the said report to 
state the name, place of birth, last residence, age and occupation of 
all such persons so afflicted. 217 
LEPROSY IN JAPAN. 
Dr. K. Yamamoto, a surgeon on board His Imperial Japanese 
Majesty's ship "Rinjio," has written the following letter at the re- 
quest of one of the physicians of this city.-Saturday Press, 1883: 
Honolulu, June 19, 1883. 
Dear Sir: I cannot give you any precise answers about the 
number of lepers in Japan, as I have not any recent reports of it 
from the sanitary office in Japan; but I think they are at present 
very few in number, probably one in twenty thousand-the whole 
population of Japan being about thirty-five millions. 
I have not seen even a single case of leprosy among Japanese 
sailors since I commenced to study and practice my profession in the 
naval department of Japan. 
In my country, leprosy is considered as an incurable and highly 
inheritable disease (same as you thought, probably), so those who 
have leprosy, or its tendency, among their families or relatives, are 
strongly refused to marry with other healthy families. 
In Japan the leprosy is not confounded with any other disease. 
In Japan there is no special hospital supplied by government for 
lepers, but there is one private leper hospital in Tokio. There is no 
special place to isolate the lepers, as Molokai in this country, but the 
lepers are confined to their own homes, and are cut off from any 
social intercourse with others, being strongly refused by all society. 
I am sir, yours faithfully, 
K. Yamamoto, II. I. J. S. "Rinjio." 218 
LEPEOSY IN THE SANDWICH 
ISLANDS. 
FROM DR. JOHN S. MC GREW TO GENERAL JAMES M. COMBY. MEDICA1 
RECORD, N. Y., 1881. 
Honolulu, September 26, 1878. 
To His Excellency General James M. Comby, 
United States Minister Resident. 
Dear Sir : In answering the letter handed to me by yon from Dr. 
Me Bride of San Francisco, I am compelled to be very brief. 
The life of a physician here cannot be said to be a sinecure. If 
I had the ability I have not the time to devote to the subject to 
make it interesting, I fear, to your correspondent. 
The first question, "When leprosy first made its appearance in the 
Sandwich Islands," is rather a hard one to answer, as the "oldest 
inhabitant," who is generally as unreliable as other people, is not 
satisfied as to the date. From the very best information that has 
been obtained, it has always existed among the natives of the Isl- 
ands. The most intelligent natives say that their earliest traditions 
give an account of this disease; that it was not introduced by the 
Chinese, as some people want to have it. 
Second.-"Are all cases of leprosy excluded from intercourse 
with society?" Very generally. From political and other influences 
with officials of the Government, many are permitted to go at large 
without being questioned-really dangerous cases of leprosy. 
Third.-" Do foreigners (other than Chinese) have leprosy in the 
Islands?" I am credibly informed that there never was a Chinaman 
landed here with leprosy from China. What few Chinamen have the 
disease, have contracted it since their arrival here, from association 
and cohabitation with leprous natives. The Leper Hospital contains 
several English, German and American lepers; quite as many of 
either of these nationalities as Chinese. 
Fourth.-" Do physicians on the Islands consider leprosy con- 
tagious or infectious?" Most of our physicians, I might say all, 219 
have every reason to believe it to be both contagious and in- 
fectious. 
Fifth.-" Is it a fact that a certain Island is set apart for the care 
of lepers? A portion of the Island of Molokai was set apart by 
an Act of the Legislature in 18GG, for this class of unfortunates. 
This was considered a necessity, and of the greatest importance 
to the public health. They are well cared for at the settlement; 
they have food, clothing and medicine furnished at great expense by 
the Government, and are more comfortably situated than they could 
possibly be at their own homes. Still, the mortality is very great at 
the settlement. It has been in existence abont thirteen years; there 
have been, in all, about 1, 850 patients admitted; the number of 
deaths for the same period is 1,140; leaving over GOO still there. 
Hoping, my dear sir, that the questions of Dr. McBride are 
answered, I am, very truly, 
John S. McGrew. 
THF QUESTION OF CONTAGION 
IN LEPROSY. 
DR. WHITE IN AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 
OCTOBER, 1882. 
In the earliest times and during the medieval ages leprosy was 
considered and treated as a contagious disease. But when, by the 
practice of seclusion, rigidly enforced during many centuries, the 
disease had nearly died out in Europe, men became ready to accept 
nearly every positive doctrine concerning its etiology put forth by 
individual observers or scientific bodies. Thus it has happened that 
during the present century the opinion has been almost universally 
adopted by the medical profession that leprosy is not contagious, 
and that it is endemic mostly because it is hereditary. There have 
not been wanting, however, observers who have stoutly combatted 
this exclusive doctrine, and who claim that the facts which point to 
the contagious character of the disease have been neglected or mis- 220 
interpreted. The many other causes which have been assigned are 
so diverse and contradictory that they call for no consideration. The 
theories of heredity and contagion, however, are not incompatible, 
they support each other. We have an illustration of such an 
etiological relation in syphilis. The important point to be deter- 
mined is the proof of the latter, not the disproof of the former. 
Fortunately for the solution of the question we have in the recent 
introduction of leprosy into an insular nation (Hawaii) and in 
several freshly developed foci of the disease upon our own continent 
(New Brunswick, Cape Breton, North Western States, South Car- 
olina, Louisiana, California and Oregon), that virgin field for ob- 
servation so essential for the proper study of this subject. The les- 
sons drawn from the data thus supplied seem to be confirmed by the 
teachings of history-and those lessons, or deductions, appear to 
justify the following conclusions: 
Leprosy has spread under recent observation, when introduced' 
into a previously unaffected stock, in so rapid and general a way as 
to prove that it may diffuse itself universally through a nation, in- 
dependently of the action of hereditary tendencies. There is no 
evidence to support the assumption that this wide and quick exten- 
sion of the disease has been caused or aided by any peculiarity of 
soil, climate, diet, or other telluric agency in Hawaii. The history 
of the affection on the other hand, leads to the strongest conviction 
(scientific proof is well nigh out of the question) that it is com- 
municated directly from person to person, while the peculiar cus- 
toms offer a satisfactory explanation of its unparalleled spread. The 
history of the little centre of disease in Louisiana, watched fortun- 
ately from its very beginning, leads to the same conclusion that it 
affects persons not under any law of heredity, but through the in- 
timacy of personal relationship, the customs and morals determining 
Largely the rapidity and universality of its spread. So too, syphilis 
abstracted from its venereal relationships, could exist as a disease, 
and does communicate itself in no inconsiderable measure in various 
other ways. It is only through the assistance of the loose sexual 
customs or certain grades of the population everywhere that it has 
become such a world-wide pestilence. Take away from it its char- 
acteristic initial lesion, and give it a greatly prolonged incubative 
stage, and the difficulty of determining the circumstances of inoc- 
ulation would be as great as in the disease we are considering. 
It is probable that leprosy may like syphilis, be communicated 221 
under all circumstances by which some of the fluids and other pro 
ducts of the infected foci of a diseased person come in contact with 
abraded or excoriated, possibly with the uninjured surface of a 
healthy person. It would be necessary that the diseased products 
should be at the surface of the skin or mucous membrane, and this 
would generally be accompanied during the process of softening by 
which the impermeable layers were removed. Thus the nodular 
form in its ulcerative stage would necessarily be the most dangerous 
phase of disease, whereas the anaesthetic form might exist for years 
with little danger of communicating itself to its surroundings. In 
this sense we may conclude that leprosy is contagious, and in these 
ways, probably, the disease mostly spreads in a family, a community, 
a nation. Hereditary transmission need not be excluded as a direct 
cause in individual cases, although as to how largely the disease 
originates in this way, and how remotely such influences may ex- 
tend, our exact knowledge is very deficient. 
But if contagious, what is the contagious element in the disease? 
A constitutional virus peculiar to it, or a foreign organism, an en- 
tophyte, which is the sole cause of the local tissue changes, and in- 
directly of the subsequent systemic changes? The latter theory 
offers, apparently the most satisfactory explanation of the peculiar 
features of the affection, while of the actual existence of the so- 
called bacillus leprce in the various tissues of the disease there can be 
no doubt and but little as to its nature. A priori, there is no reason 
why the bacterium found may not satisfactorily explain all the local 
and general pathological process characteristic of the disease, and 
it has been found in connection with cases from so many parts of the 
world, and by so many reliable and experienced observers, and has 
under all circumstances, presented so uniformly identical appear- 
ances, that the probability of such specific relationship grows 
stronger and stronger. The results of inoculation are as yet 
negative. 
If, then, we are prepared to admit the contagious nature of 
leprosy, what measures should be taken for the exclusion from, and 
repression within the country? We have at present an unknown 
number of lepers in the United States, let us say fifty or a hundred; 
three undoubted centres of contagion, affecting three entirely dis- 
tinct nationalities, in different climates, and under quite diverse 
methods of living. It is evident that the disease may make more 
rapid advance in one part than in another. Any circumstances, for 222 
instance, which tends to soften or abrade nodules, as a hot climate 
possibly, would of course greatly increase the danger of infection, 
so that the necessity of interference by compulsory means might be 
more urgent in the former than in the latter. It is evident, how- 
ever, that such measures should be undertaken by the national 
government, and that they should be made applicable to all parts of 
the country alike. These measures should be the establishment of 
graded hospitals in possibly insular localities in various parts of the 
country, to which all access should be prevented, except under re- 
strictions determined by professional rules; the enactment of laws 
which should make residence compulsory and perpetual, and the 
concealment of the disease punishable by severe penalties. 
These rules should apply to so-called sporadic as well as to en- 
demic and imported cases, but the latter should be given the option 
of returning to their native land. The immigration of lepers should 
be prohibited and arrested at ports of arrival by inspection so far 
as possible, as other contagious diseases now are by quarantine 
regulations. By the establishment of such national measures, im- 
migration from leprous countries would largely cease, lepers would 
no longer change their residence within the country to escape the 
action of local laws against their liberty; marriage with them would 
become abhorrent when the people had thus become aware of its 
dangers, and after a generation has passed the disease should be 
virtually eradicated. 
Lepers belong to the dangerous classes of the community which 
require perpetual confinement, and the sooner this remedy is ap- 
plied the less seeming cruelty will attach to it. 223 
THE BACILLUS OF LEPROSY* 
WM. T. BELFIELD, M. D., JOURNAL OE CUTANEOUS AND VENEREAL 
DISEASES, N. Y. JULY, 1883. 
Fourteen years ago, Hansen announced the discovery of bacteria 
in certain cutaneous nodules removed from patients afflicted with 
tubercular leprosy. His demonstrations were 'not, however, entirely 
satisfactory; for he offered no other proof of the bacterial nature 
of the bodies in question than their general appearance, size and 
shape; and the methods which he employed, though the best then 
devised, failed to give a satisfactory picture. At this time, indeed, 
(1869) but little attention had been bestowed by pathologists upon 
the possible pathogenetic relations of bacteria, and had Hansen 
furnished even an unequivocal demonstration of his assertion, it is 
scarcely probable that the incident would have attracted much 
attention. 
Within the next decade, however, the role of bacteria in disease 
became a question of absorbing interest, an object of most exten- 
sive and assiduous investigation. Among the fruits of this study 
were the introduction of accurate and trustworthy methods for the 
detection and recognition of bacteria-for distinguishing these 
minute organisms from cell-debris, crystals, organic granules, and 
other objects of similar appearance. These methods-due chiefly 
to the ingenuity and industry of Weigert and of Koch, consist, as 
is well known, in the use of the aniline colors for staining, of the 
Abbe illuminator, and of special methods for the cultivation of 
bacteria. In 1878, Neisser, then a private docent in Leipzig, now 
professor of dermatology in Breslau, having thoroughly familiarized 
himself with these methods, spent some months in Spain for the ex- 
press purpose of studying the pathology and history of leprosy, f 
He reported as the result of these investigations, the presence of a 
bacillus of specific size and shape in every leprous patient, yes in 
*Vide Report of Dr. Edward Arning. Appendix I, page xxxvii. Van- 
dyke Carter, " Leprosy in India," page 100. 
t Virch, Arch. Bd. 84. 224 
every leprous tissue examined; not only in the cutaneous nodules, 
but also in the neoplasms of the mucous membranes, mouth, 
pharynx, and larynx; in the liver, spleen, lymph-glands, nerves, 
cartilage, and testicle. He was unable to detect the organism in the 
blood. 
Examinations by other observers, prominent among whom may be 
mentioned Eklund and Kobner, have unanimously confirmed these 
assertions of Neisser, and have demonstrated the accuracy of the 
original observations of Hansen. Although leprous tissue is com- 
paratively scarce material, and opportunities for observation there- 
fore somewhat limited, yet there has been such perfect unanimity of 
results among all observers as to justify generalization. For no one 
who has sought intelligently-i. e., has properly used the aniline 
colors, etc.,-has failed to find the bacilli in tissues properly pre- 
served and not too old. J 
* * * * * * * 
The bacteria are found usually within the characteristic large 
cells which constitute the mass of the leprous neoplasm ; sometimes 
two or three bacilli may be seen in one of these cells. Occasionally 
a few stragglers are observed lying in the intercellular spaces also. 
The individual rods are 1-5000 to 1-G500 inch in length, often some- 
what thicker in the middle than at the extremities, exhibiting 
therefore a spindle shape. Like other bacteria, they are character- 
ized by their affinity for certain [(basic) aniline colors-blue, red, 
and violet especially. In sections of recent tissues the bacilli can 
be stained with the ordinary two per cent, aqueous solution of the 
aniline colors; if the tissue has been long exposed to alcohol, the 
sections should be first treated with a ten per cent, solution of 
caustic potash, after which they may be stained.51 
The writer's personal knowledge of these bacilli is limited to two 
cases. A cutaneous nodule was removed intra vitam from a private 
patient by Prof. v. Frisch, of Vienna, and placed at once in ab- 
solute alcohol. Sections made a few days later and stained with 
aniline showed the bacilli in and among the large cells which con- 
stituted the mass of the nodule. During a recent visit the writer 
I After soaking in alcohol for some years or even months, the bacteria 
often fail to respond to the staining agent, and may be therefore readily 
overlooked. 
51 For details see Appendix B. to the author'sCartwright Lectures." 
W. T. Keener, Chicago, 1883. 225 
had the pleasure of exhibiting one of the seetions to numerous 
gentlemen in New York and Philadelphia, including several mem- 
bers of the New York Dermatological Society. 
The second case was a patient in New York, from whom a piece of 
skin was excised and presented to me by Dr. II. G. Piffard ; sections 
treated with aniline gave essentially the same, appearance as in the 
first case, except that the bacilli were perhaps less numerous. 
But little is known as to the natural history of this fungus. 
Neisser made cultures from lepra-nodules on blood serum and beef 
extract; he says that the rods grew into threads; that in these 
threads there subsequently appeared round glistening bodies which 
he regards as spores. Yet further observation on this point is 
needed. 
It is then established that a bacterium-a bacillus-of specific 
size and shape is a constant element of the diseased tissues in 
tubercular leprosy ; yet this fact of association does not of course 
prove that the bacillus causes the morbid process; since it is con- 
ceivable that it appears as a sequence rather than as a cause of this 
disease. This latter conception is certainly not entirely satisfactory; 
it does not plausibly explain why this bacterial variety, and this one 
only, is found and always found in the leprous nodules-but in no 
other diseased state. We attribute trichinosis to the trichina spiralis, 
though we have no other proof of a causal relation than the mere 
presence of the worm; we ascribe chyluria and lymph-scrotum to 
the filaria sanguinis hominis, although we know only that this worm 
is sometimes present in these morbid conditions. Yet the same 
men who accredit these two worms with morbific influence merely 
because of their association with diseased states, reject the idea 
that the bacillus of leprosy is anything more than the result of a 
previously established morbid process. 
Yet we are justified in declining to admit the causal relation of the 
bacillus from mere analogy, if direct demonstration be possible; and 
in the case of at least one other bacterium such demonstration has 
been actually furnished. The bacillus anthracis, as is well known, 
has been cultivated outside of the body on prepared media; has 
been separated by successive cultures from all ancient tissues; has 
been in short isolated. And it is an equally familiar fact that these 
bacilli thus isolated and then introduced into the tissues of a 
healthy animal, induce a classical anthrax. Until an equivalent 
demonstration shall be furnished for the bacillus leprte the proof of 226 
its causal relation to leprosy may be regarded as incomplete. Yet it 
is evident that the matter cannot be so easily decided for leprosy as 
for anthrax, since the former discard is peculiar to the human sub- 
ject-a subject not usually available for experimental purposes of 
this nature: it seems indeed impossible to furnish the final link in 
the chain of evidence in leprosy. 
Neisser has, it is true, inoculated animals-dogs and rabbits- 
with the isolated bacilli lepra?, and attests that nodules similar to 
those of leprosy in the human subject were produced at the site of 
inoculation. Yet one nodule does not make a leprosy, nor is there 
in fact satisfactory evidence that Neisser's nodules were of other 
than simple inflammatory origin. 
Such then is the status of the question to-day; the association of 
a specific bacillus with the morbid changes of tubercular leprosy is 
established and admitted; while the relation of the parasite to the 
morbid process is not as yet established by direct demonstration. 
*The bacillus has not as yet been detected in the so-called 
amesthetic form of leprosy. 
REPORT OF THE ROYAL COLLEGE OF 
PHYSICIANS. 
IS LEPROSY CONTAGIOUS? AYE. 
GRENADA.-1 have seen a few persons amongst those affected 
where contagion appeared evident. 
I consider that contagion will take place when ulcerations exist 
with copious discharge, and this can only occur in the first or tuber- 
culous leprosy. 
I do not think the disease in its incipient stage transmissible by 
sexual intercourse.-Dr. Aqua kt. 
GUIANA.-I have met with only two cases in which after minute 
enquiry, I believe the disease to have been communicated by direct 
contact. My own opinion is in favor of the contagiousness of 
*Vide Dr. Arning's Report, page xxxix. 227 
leprosy, and that it may be propagated by the matter of ulcerated 
tubercules being applied to any raw surface; but I admit that I 
have met with cases which would seem to preclude the idea that the 
disease can be considered contagious in the ordinary sense of the 
term. 
I have known instances where black women have cohabited for 
years with their husbands while laboring under confirmed and ulcer- 
ative leprosy, and have children by them, without manifesting the 
slightest trace of the disease.-Dr. Manguet. 
I am clearly of opinion that it is contagious in every stage and 
form, and especially so after ulceration. I have seen many instances 
which could only be referred to contagion; the convictions of the 
parties, and the most rigorous examinations of the history of the 
cases giving no clue whatever to the pre-existence of any family 
taint. It is notorious in respect of a white family of distinction in 
this colony, that, having disregarded the warnings of their medical 
advisers of the danger of permitting the young members to play in 
company with a negro boy who exhibited the symptoms of the 
disease, they one and all became infected, and the majority of them 
fell victims to the fatal indiscretion. 
The liability to the disease in this way (sexual intercourse) is un- 
doubted.-Dr. Pollard. 
From what I have seen and heard in Surinam, Dutch Guiana, 
where more attention is paid to the disease than in British Guiana, I 
believe it to be contagious. I have known an officer of high rank 
there contracting it from cohabiting with a woman whose family 
were affected with it. In Dutch Guiana, people are afraid of shak- 
ing hands with any persons who are suspected of the disease, and 
even of setting on the chair which they have occupied, or of using 
the sarhe privies.-Dr. Van Holst. 
CO^FU.-Two instances I have met substantiate the opinion that 
it is contagious after a lapse )Of time. In both, the wife became af- 
fected some years after the husband had been attacked.-Proto 
Medico. 
MAURITIUS.-I have met with two cases where the disease 
seemed to be transmissible; in the one instance from the husband to 
the wife, and in the other from a man to a child of his wife from a 
former husband.-Dr. Regnaud. 
SUMBULPOOR.-On the subject of contagion there appears to 
be some room for doubt. I have never known or heard of a case in 228 
which simple contact on one occasion has produced the disease, but 
by prolonged liability to contact with, or close proximity to diseased 
persons, there is reason to believe that the disease has been repro- 
duced.-Dr. Jackson. 
MOZUFFERPORE.-I know of many cases in which there was a 
clear proof of the contagious nature of the disease. I believe lep- 
rosy is also contagious when the ulcerative stage has commenced,and 
it appears as if the disease took a very long time to affect the sys- 
tem. It is not a matter of days, or even months but of years. 
There can be no doubt of it (transmissibility by sexual inter- 
course).-Dr. Macnamara. 
CAWNPORE.-The native doctors say it is contagious in the sup- 
purative stage.-Dr. Jones. 
BUD AON.-I have met with instances in which the disease proved 
to be contagious, after living in close proximity to the diseased per- 
sons for a long period of time, say one or two years. The malady 
was in full vigor, and there were ulcerations with a discharge.- 
Dr. Harris. 
SINGAPORE.-I have met with three cases in which I can with 
certainty state the disease was contracted by continued and direct 
contagion.-Mr. Rose. 
LABUAN.-I have not met with a case I could satisfy myself had 
arisen from contagion; but it is the universal belief among the peo- 
ple, whether Chinese, Malay, or Dyak, that it is contagious, and 
they all alike separate the lepers, and avoid all contact with them.- 
Dr. McDougall. 
IS LEPROSY NON-CONTAGIOUS? 
NEW BRUNSWICK.-I am thoroughly convinced that the 
disease, in Tracadie, is not contagious, and that it is not transmiss- 
ible by sexual intercourse.-Dr. Bayard. 
I have never met with an instance of leprosy being communicated 
to a healthy person by contagion.-Dr. Nicholson. 
Several lepers have cohabited with their wives for years, and no 
infection was communicated to them.-Dr. Benson. 
JAMAICA.-I am certain that it is in no way contagious, and 
that it is not transmissible by sexual intercourse. The evidence 229 
against the contagion of leprosy, in all its forms, is irrefragable.- 
Dr. Fiddes. 
BAR BADGES.-I have not met with any cases of contagion. 
None of those in attendance, during the last nine years, upon the 
inmates of the lazaretto have contracted the disease; and I, after 
receiving a wound from a knife, moistened with the fluids of an in- 
mate, have escaped, although the wound was followed by great con- 
stitutional irritation and loss of the finger. From what 1 have 
heard 1 do not believe it communicable by sexual intercourse.- 
1). Browne. 
TRINIDAD.-I have never met with a single instance of it ap- 
pearing to be so. 
The disease has not been transmissible by sexual intercourse in 
many cases which have been under my care, and which most de- 
cidedly confirm my opinion that it is not contagious.-Dr. 
Saturnin. 
CAPE of GOOD HOPE.-I have not seen a single case where it 
was communicated by contagion. I have known lepers cohabiting 
with females who remained exempt.-Dr. Ebden. 
JERUSALEM.-I have never heard of such instances.-Consul 
Finn. 
DAMASCUS.-It is not contagious and not transmissible by sexual 
intercourse. 
RHODES.-It is entirely exempt from contagion, or transmissible 
by sexual intercourse. 
MYTELENE.-It is demonstrably not contagious. 
CRETE.-There are 127 persons who have all lived together 
healthy among lepers for many years.-Dr. Brunelli. 
CORFU.-I have never been able to recognize the contagiousness 
of leprosy. Women have often lived with leprous husbands without 
contracting the disease.-Dr. Tygaldos. 
TABREEZ.-I have met with no case of dircect contagion.-Dr. 
CORMICK. 
SHANGHAIE.-I have never met with an instance of the disease 
appearing to be contagious.-Dr. Henderson. 
VICTORIA.-No instance of apparent contagion has been met 
with in this country. 
CEYLON.-I have no reason to consider it contagious, or trans- 
missible by sexual intercourse.-Dr. Davy, 230 
I have not met with a single case of contagious communication of 
the disease, although popular belief in this country is strongly in 
favor of its communicability.-T. A. P. 
I have not known a single instance in which a wife whose husband 
was a leper, was affected by this disease, whereas numerous in- 
stances have come under my observation in which the offspring of a 
diseased person has been affected.-T. G. 
BOMBAY PRESIDENCY.-None of the observers appeared to 
have obtained conclusive proof of leprosy being contagious, or trans- 
missible by sexual intercourse. 
MADRAS.-Leprosy does not appear to be contagious. 
BENGAL.-It is not a contagious disease in the ordinary sense of 
the term, nor does it seem communicable by sexual intercourse.- 
Dr. Jackson. 
CALCUTTA.-Never. It is transmissible by sexual intercourse. 
ARRAU.-As far as I can ascertain it is not known to be contag- 
ious or infectious.-Dr. Hutchinson. 
CAWNPORE.-I have met with none. 
SEROLIE, JUDPOORE, ULWUR, JEYPORE, HAROWTEE, 
NAGPORE, and MOULMEIN, also negative. 
KYOUK PHYOO.-1 have never met with an instance. I do not 
believe it is transmissible by sexual intercourse.-Dr. Thomas. 
AKYAB.-1 have seen nothing to induce me to believe that 
leprosy is contagious, and I do not believe that it is ever commun- 
icated in this way, nor ever by sexual intercourse. 
IS LEPROSY HEREDITARY? 
NEW BRUNSWICK.-It is certainly hereditary. Some members 
of a family may be attacked and others remain exempt. Dr. 
Bayard. 
JAMAICA.-It is frequently hereditary-particularly in the third 
generation.-Dr. Fiddes. 
DOMINICA.-My belief is that leprosy is hereditary.-Dr. 
Murray. 
BARBADOES,-It does appear to be hereditary, but I cannot say 
often so.-Dr. Browne. 231 
There can be no doubt of its being hereditary.-Dr. Stevenson. 
GUIANA.-It is undoubtedly hereditary. The disease often 
overleaps an entire generation to re-appear in the next; the immun- 
ity may commence in the immediate family of the leper himself. It 
is possible that many cases presumed to be of hereditary origin are 
instances either of extraneous contamination, or of the propagation 
of the disease from one member of a particular family to the others. 
-Dr. Pollard. 
CAPE of GOOD HOPE.-Most decidedly hereditary.-Dr.Ebden. 
SIERRA LEONE.-Invariably, as far as I can ascertain. It gen- 
erally skips a generation.-Mr. Bradshaw. 
DAMASCUS.-Few lepers have children; but when they have, 
some of the children are diseased and others are not. 
SAMOS.-Yes. Certainly. 
CONSTANTINOPLE.-Yes. Certainly, yet it often appears 
spontaneously. 
CANTON.-Leprosy is undoubtedly a hereditary disease. It is 
said to become mild in the third generation and run itself out in the 
fourth.-Dr. Hobson. 
MAURITIUS.-Unequivocally so.-Dr. Regnald. 
CEYLON.-It is often hereditary.T. A. P. 
BOMBAY.-Opinions are divided as to whether it is often hered- 
itary, Dr. Carter thinking it is. 
MADRAS.-By statistics, inheritance does not constitute a strong 
predisposition to the disease.-Day, Porteous, Shortt, Shaw. 
BENGAL.-Yes, the disease does often appear to be hereditary.- 
Durant. 
FUNEEDPORE.-Notwithstanding its undoubted power of trans- 
mission from parent to offspring, it is also a noted fact that it is 
often capable of spontaneous origin, and that these idiopathic cases 
are just as numerous, if not more so, especially in the tropics, as 
those which can alone be traced to parental influence. 
ARRAU.-Hereditariness is the predisposing, and bad food the 
exciting cause of the disease; the fact of its appearing among the 
rich and wealthy shows that it must be hereditary. 
BENARES.-All but Dr. Dale consider the disease to be hered- 
itary ; the natives believe it to be so.--Dr. Dunbar. 
SEHARUMPORE.-The belief in its hereditary transmission was 232 
so deeply grounded in the minds of the Punjaubees generally, that 
they were in the habit of burying alive, not only the leper himself, 
but also his relations and friends, lest in midtiplying their kind, the 
disease would be communicated to distant generations. 
LAHORE.-It is often hereditary but not always so.-Bose. 
NIMAR.-The disease in several cases would seem to be hered- 
itary. Cases pass over a generation frequently.-Hunter. 
NAGPORE.-Out of 228 cases it. was hereditary in 40. 
AKYAB.-That leprosy is hereditary is a belief universal in India. 
-Nisbet. 
IS LEPROSY CONNECTED WITH SYPHILIS? 
NEW BRUNSWICK.-It is a disease by itself. Syphilis and 
yaws arc unknown in the district where it prevails.-Nicholson. 
JAMAICA.-Disease by itself. I have little doubt yaws and 
leprosy may run their course together as also leprosy and syphilis.- 
Bowerbank. 
DOMINICA.-No. Inbray. The yaws is a disease different in 
its nature. 
ST. VINCENT.--1 think it is connected with scrofula but not 
with any other disease. 1 regard leprosy as a form of scrofulous 
disease.-Checkley. 
BARBADOES.-It is a disease sui generis.-Goding. 
I will not say that syphilis can produce true leprosy; but that it 
can produce a disease so closely resembling it as to deceive the most 
careful observer, I fully believe. It is most common in the off- 
spring of syphilitic patients.-Stevenson. 
TOBAGO.-I look upon leprosy, syphilis, and yaws as cognate.- 
Purser. 
TRINIDAD.-I have not, but syphilis and yaws may co-exist 
with it. 
GUIANA.-Leprosy is a disease sui generis, independent of any 
other disease.-Reed. 
Specifically from any other disease.-Pollard. 
I firmly believe leprosy to be connected with syphilis, yea, even to 
be an offspring of it; imperfectly cured syphilis in parents causes 
the disease to break out in the progeny of the second, third or fourth 
generation.-Van Holst. 233 
DAMASCUS.-Leprosy is a separate and independent disease, 
known in Arabia for many centuries, and mentioned in the Koran by 
Mohammed under the name of " Jezam;" whereas syphilis was not 
known here until the French invasion under Napoleon, when his 
soldiers brought it hither, whence it is called Hal Franji, or the 
Frank evil. 
CRETE.-Although there are certain symptoms in the first stage 
of the disease resembling those of syphilis, it is not connected in 
any way either with that or any malady. 
TABREEZ.-No. Syphilis is rare in the villages of Persia. 
MAURITIUS,-I have not. In two cases the disease declared 
itself at the same time with a syphilitic eruption. After the disap- 
pearance of the latter, the leprosy continued. 
CEYLON.-Scrofula and syphilis would lead to leprosy under 
favorable conditions, but that leprosy is a constitutional form of 
syphilis, I do not think.-II. I). 
Leprosy is often dependent or connected either directly or re- 
motely with syphilitic taint.-T. A. P. 
The majority of cases under my observation wrere connected with 
syphilis.-T. S. 
BOMBAY PRESIDENCY'.-Opinion is decidedly against the con- 
nection of leprosy with syphilis, yaws or any other disease. 
MADRAS.-Syphilis is extremely common among the natives of 
India, and all the reporters who have come in contact with leprosy 
mentioned syphilis as no uncommon complication. In none of these 
reports is connection traced between leprosy and syphilis. 
BENGAL.-I have no reason to believe that leprosy is in any de- 
gree dependent upon syphilis or any other disease. 
MOORSHED ABAD.-Leprosy is very often connected with, if 
not dependent on syphilis and the abuse of mercury in native prac- 
tice.-Fleming. 
PUBNA.-In connection with syphilis but in some cases with 
scrofula.-Parker. 
SERAMPORE.-In cases of secondary syphilis in which mercury 
has been administered over and over again the disease has not un- 
frequently degenerated into leprosy. 
BHANGULPORE.-I have very' good reasons to know that lep- 
rosy is dependent on syphilis, for I have known several cases to have 
been preceded by syphilis.-Crewe. 234 
ALMORAH.-The natives themselves believe leprosy to depend 
very often on a syphilitic taint, but I am disposed to think this alto- 
gether a mistake. No doubt with a predisposition to leprosy already 
existing, if a person's constitution becomes tainted with syphilis, 
this, like any other cause, may develop the disease, but I think the 
morbific cause of each is quite distinct.-Merton. 
HILL STATES.-No. Yet syphilis is extremely common.- 
Gurdex. 
* 
BHUTTEEANA.-Yes, more than half the cases were sufferers 
from syphilis in one form or another. 
LAHORE.-Is often, not always, dependent on syphilis, which 
may be considered as one of its most powerful predisposing causes. 
- B< )SE. 
JODHPORE.-1 believe a person atllicted with secondary syphilis 
will be more likely to become the subject of leprosy, in consequence 
of the cachexia the first named disease induces. 1 believe both 
diseases may exist and become as it were blended together. 1 do 
not think there is any such disease as syphilitic leprosy, that is lep- 
rosy arising from syphilis as an exciting cause.-Moore. 
GWALIOR.-It is a distinct disease, but it may have some con- 
nection with scrofula.-Sutherland. 
NIPAL.-I do not believe that syphilis, except in cases where 
there is a decided constitutional or inherited tendency to leprosy, 
has anything to do with its development, although syphilitic eruptions 
often assume a decidedly leprous character.-Oldfield. 
AKYAB.-Probably mercurial and syphilitic poisons may induce 
a cachectic condition of system highly favorable to develop leprosy 
where the hereditary taint exists.-Nisbet. 235 
EXTRACTS FROM NOTES ON " A FEW CASES 
OF LEPROSY." 
J. H. BEMISS, M. D., LAHAINA, MAPI, II. I. 
NEW ORLEANS MEDICAL AND SURGICAL JOURNAL. APRIL, 1880. 
* Statistics as to the time and manner of introduc- 
tion of leprosy into the Hawaiian Islands are wanting. The period 
between 1825 and 1830 is supposed to approximate to the correct 
time of importation, though the evidence to that effect is very in- 
definite. Rev. W. P. Alexander who came here in 1833, says the 
first case he met with personally was that of a native Hawaiian in 
about 1838, living in a very isolated locality on this island (Maui), 
but he had heard several years before that a chiefess in Lahaina- 
also on Maui-was affected with the disease. The first case on the 
Islands was said to have been that of a Chinaman on Oahu, the is- 
land upon which Honolulu is situated. 
Of course the manner of introduction is just as uncertain as the 
time. The means of importing it, however, have been unlimited. 
During the height of the whale hunting business, that is, during the 
first half of the present century, these islands were the great resort 
for the whaling fleets of the Pacific, as many as a hundred sail often 
being in the harbors of Honolulu, Oahu: or Lahaina, Maui, at one 
time. These vessels in addition to bringing sailors from all parts of 
the world, frequently shipped native crews, who in their cruises 
were brought in contact with all nations along the Pacific, and after- 
wards returned here to spread such diseases as they might have con- 
tracted. But before whalers ever touched at these islands, the 
natives are said to have occasionally gone from island to island in 
^he Pacific, exchanging their diseases as well as their commodities, 
which latter, however, were probably very limited. It may be then 
that the disease was present here in a dormant state long before it be- 
came generally known-at least to foreigners. The old disease, 
" mai alii"-" chief's disease "-is generally supposed to have been 236 
Elephantiasis Arabum, or else the result of high living, in which the 
chiefs indulged. Some, however, have thought it not too much to 
suppose some of the cases to have been leprosy. 
The natives call leprosy " mai pake," "Chinese disease,'" the 
tradition among them being that the "heathen Chinee" brought it 
with them. But the first lot of Chinamen did not come here until 
quite a number of years after leprosy became known, and this 
charge seems the more unwarrantable when we consider that of the 
whole population at the leper asylum there are not over six China- 
men. 
After its introduction it seems to have spread quite slowly until 
the latter part of the ten years, 1850-1860. It then became so 
plentiful that the government took alarm and began to institute 
measures looking toward the prevention of its spread: one of its 
acts being the establishment of the Leper Asylum on Molokai, and 
the forcible transfer of pronounced cases to that place. The census 
of 1878 (December 21st). showed the number of lepers at the 
Asylum Kalawao, at that date to have been 806 ; since then quite a 
number have been added, though there are still many at large. 
There have been admitted to Kalawao certainly not less than 2,000 
persons from 1866 to date; of which number upwards of 750 are 
still alive. 
The total native population, excluding all foreigners and those 
born of foreign parents, is 44,088 (census of 1878), quite a small 
number to furnish so much leprosy. The large majority of these are 
full blood natives or half breeds, there being two whites,-one 
American, the other English, and less than a half dozen Chinamen. 
There are present here, the two forms, tubercular and anaesthetic. 
This division is based upon the predominance of one or the other of 
the two most important symptoms. In actual observation the dis- 
ease does not always admit of such strict classification, but generally 
shows the two forms combined in greater or less pathologic pre- 
ponderance. It may start as purely tubercular or purely anaesthetic, 
but does not often preserve a single type throughout its course ; in 
the one case anaesthesia, in the other tubercules making their appear- 
ance in due time. As to a third variety, macular, my observation 
does not warrant my stating any such class. True maculae of one 
sort or another are common enough, but these cases already present 
one or the other of the two forms generally recognized. I have 
seen but one case in which I was not easily able to observe tuber- 
cules or anaesthesia well marked. 237 
This man had several large, light and slightly raised maculae upon 
his body, as the only main symptom of the disease, but these were 
anaesthetic, and there was a slight enlargement of the ahe nasi due 
to infiltration, one of the phenomena of incipient tubercular 
leprosy.* 
The tubercular variety is characterized by infiltration and sub- 
sequent hypertrophy of the skin, especially where there is much 
loose tissue, such as the lobes of the ears, ake nasi and face gener- 
ally. Later on there is deposited in the skin of the face, hands, 
arms, etc., cheesy masses of the size of a pea or a little larger. 
These tubercles are prone to break down and leave deep indolent 
sores, which heal, however, after a time, but with strangly marked 
cicatrices. Mucous membranes, just as the external skin, are liable 
to the above morbid changes. They may become infiltrated and 
hypertrophied, or tubercles may appear in their substance and under- 
go ulceration. When such changes occur in the larynx an alteration 
of the voice is the result. In breaking down, they produce a most 
offensive fetor of the breath. The same changes occuring in the 
mucuous membrane of the intestines are in a certain proportion of 
cases the cause of the diarrhoea which is so common, and so often 
fatal. But in many instances diarrhoea is only one of the many in- 
tercurrent affections due to a vitiated state of the system. In cases 
primarily antesthetic, I have on several occasions first observed tuber- 
cles upon the mucous membrane of the posterior part of the tongue 
and pharynx, as the only localities where they may be seen at that 
stage. 
The anaesthetic form is marked by all those phenomena which are 
the result of degenerative changes in the nerves. These are 
anaesthesia, paralysis, contractions and distortion, especially extreme 
flexion or extension of the fingers and toes, also ectropion, loss of 
smell and taste, wasting of muscles, vesicles, sloughing of fingers 
* After having prepared this for the mail, I was upon Molokai on profes- 
sional business, and there saw a ease more purely macular than the above. 
The child a girl ten years old, presented upon her face especially, but also 
elsewhere upon her body, large black maculae,slightly raised above the sur- 
face and producing a very disastrous effect upon her appearance. She was 
so young, that it may be she did not understand my questions; at all 
events, neither by questions or close examination could I obtain any ev- 
idence of anaesthesia. Scattered from her left eye brow to her hand were 
not loss than six small tubercules, on her right hand there were about half 
as many. 238 
and toes, etc. The ulnar and facial nerves are especially frequently 
affected, but all are liable. 
It is with difficulty that any history of a prodromic stage can be 
obtained from a native. They are by no means observant of such 
matters, but occasionally one may be found who will complain of a 
general indisposition extending over a period of several months or 
even longer. 
When amesthesia plays an important part from the first, the 
patients very frequently speak of formications, over the entire body 
sometimes, but especially over the nerves which afterwards become 
amesthetic. 
It will be noted that syphilis or any syphilitic cachexia were in 
every case diligently sought for, for there are some on these islands, 
as well as in India and elsewhere, who hold to an intimate connec- 
tion between syphilis and leprosy. If there is any such relation as 
they claim, then it is unnecessary to speculate as to the manner of 
introduction of leprosy into this Kingdom, for though my experience 
in foreign lands is confined to these Islands, I am not prepared to 
read of a country where syphilis is so prevalent, so grounded into 
the whole native population as here. The problem, then, would be, 
how long the disease-syphilis-left to itself, would require to be- 
come elaborated into leprosy. But I am not willing yet to adopt 
such an hypothesis, for then should leprosy be more general in the 
families of those affected, as well as more common in other countries, 
where there is a certain proportion of families thoroughly imbued 
with syphilis, and from which they have not been exempt for several 
generations. Again, anti-syphilitic treatment should give some good 
results, which is not the case, save when syphilis is added to the 
disease. Moreover, the symptoms of the two diseases do not coin- 
cide in a way to warrant such an opinion. 
Vaccination was also inquired into. Alarmed by an invasion of 
small-pox in 1853, a general vaccination of the whole population 
was ordered, and physicians being at that time very few on the 
Islands, non-professionals aided in the work. It is charged by 
some that, as a natural result of the labors of the heterogeneous 
force so appointed, not only syphilis but also leprosy was greatly 
increased. In my last circuit trip in my district, I found very few 
adults who had never been vaccinated. 239 
This involves the question of inoeulability, in my opinion the 
main, if not the only means of propagation, other than inheritance. 
That is, like syphilis it depends for its propagation upon the direct 
introduction of its virus into the blood. The general immunity of 
those coming in constant contact with lepers points to the absence of 
any direct contagious quality. INDEX. 
PAGE 
Abbott. Massachusetts Health Report. - 205. 
Aguirre. Chili. - - - 168. 
Agra Leper Asylum. - - - 60. 
Ahmedabad Hospital. - - - - - 55. 
Almora Leper Asylum. - - 58. 
American Dermatological Association. - - - 197. 
Amritsar Asylum. ------ 63. 
Amsterdam. Dr. Van Deventer. - 186. 
Ancient India, Leprosy in - - - - - 80. 
Asylums. - - - - - 50-65. 
Atreya on Leprosy. - - - - 80 
Bacillus of Leprosy. Belfield. - - - - 223. 
Backergunge. Murray, W. F. - - . 35. 
Barbadoes. - ... 229. 
Barcelona. The Faculty of - - 194. 
Bankoora. Dutt. - - - - - 20. 
* " Jail. Bengal. - - - - 57-78. 
Barrh. Zaheerudeen. ----- 40. 
Banerjee. Bengal. - - - - - -14. 
Beehar Cooch. Comins. - - - - - 41. 
Belfield. Bacillus of Leprosy. - - - - 223. 
Bemis. " Notes on a few cases of leprosy." - 235-239. 
Bengal. Banerjee. - - - - - 14. 
Bensley, C. E. W. Dumka. - 26. 
Bensley, E. C. Rajshahye. ... 28. 
Bombay. Darmshala Asylum, - - - 53. 
" Jeejeebhoy Hospital. - - - 54. 
" Moore. - - - - 12. 
British India. Report from - - - - 9-101. 
Brunswick New. Graham. - . - 157. 
" " Smith. - - - - 154. 
" " Tache. t 135. 
Calcutta. Ghose. ... - - 14. 
" Leper Asylum. ... 55. 
California. San Francisco, Meares. • • -214, 241 
PAGE 
Canada. New Brunswick. Graham. - - 157. 
" " Smith, A. C. - - 154. 
" " Tache. - - 135. 
Canary Islands. Torrens. - . - 158. 
Canney. Trichinopoly Leper Hospital. - - 51. 
Carter. II. Vandyke. Notes of cases treated. - - 72. 
" Norway. (1884). - - 82. 
* " Pathology of Leprosy. - - 100. 
" Prevention by Segregation. - 82-101. 
Caspersen. Norway. - - - - 191, 
Ceylon. Kynsey. - - - - 161. 
Chatterjee. Ruthgora. - 22. 
Chili. Thomas. - 168. 
Chittagong. Murray, R. D. - 36. 
Chumparum. Civil Surgeon. - 34. 
Cockburn. Hooghly. - - . - 16. 
College of Physicians (Eug). ... 226. 
Comins. Cooch Behar. - 41. 
Contagion. Question of, White. - - - 219. 
Contai. Mookerjee. - - - - - 23. 
Cooch Behar. Comins. - - - 41, 
Countries. Reports from Foreign - - -102-218. 
Crombie. Dacca. - 36. 
Cunningham and Lewis, Kumaun. ... 78. 
Cuttack. Stewart. - - - - 37. 
Dacca. Crombie. - 36. 
Darmshala Asylum. - 53. 
Dehra Dun Leper Asylum. ... 59. 
Dermatological Association of America. - - 197. 
Deventer Van J. Netherlands. - 186. 
Doss. Ghattai. - - - • - 22. 
Dougall's treatment. - - - - 75. 
Duiagepur. Webber. . • - - 34. 
Dumka. Civil Surgeon. ... 26. 
Duncan. Julpaiguri. - 29. 
Dutt. Bankoora. - 20. 
Egeling. Holland. - - - - 176. 
Eklund. Sweden. .... 198, PAGE 
Farquharson. Iowa. .... 19$. 
Farrar. Iowa. - - - - - 204. 
France. Academy of Medicine. ... 168. 
Ghattai. Doss. .... 22. 
Ghose. Calcutta. - - - - - 14. 
" Rungpur. -1 - - - 32. 
Gomez. Mexico. .... 178. 
Goopta. Patna. - 39. 
Graham. Canada. - - - 157. 
Greene. Serampore. .... 20. 
Gronvold. Norway. .... 202. 
Guatemala. Valladores and Yela. - - 173. 
Gupto. Midnapur. - - - - v 24. 
Gurbetta. Sein. - - - - 23. 
Hawaiian Islands. Bemis. ... 235-239. 
Hill. Monghyr. - ... - 40. 
Holland. Egeling. .... 176. 
Hongkong. Keswick. - - - - 177. 
Hooghly. Cockburn. - - - . 16. 
Hospitals, Asylums, etc. India. - - - 50-65. 
Illinois. ..... 198. 
India. British. Leprosy in. - - - - -9-101. 
Iowa. - - - - - - 198. 
Japan. - - - - . 217. 
Jeejeebhoy Hospital. - . - - 54. 
Jessore. Wright. .... 35, 
JuHundur Asylum. .... 62. 
Julpaiguru. Duncan. - . - 29. 
Kangra Asylum. - - - • - 61. 
Keswick. Hongkong. - . . 177. 
Kumaun. Lewis and Cunningham. - - - 78. 
Kurtzhaiss. Siam. ... . 193, 
Kynsey. Ceylon. - - - - - 161. 
Leprosy in Ancient India. Atreya. - - 80. 
" in the Sandw ich Islands. Melina. - - 218. 
Lewis. Kuinaun. .... 78, 
242 243 
PAGE 
Mackenzie. Secretary Government of India. - - 9. 
Madras Leper Hospital. Thompson. - - 50. 
Massachusetts Board of Health. - • - 205. 
Matthew. Midnapur. - - - - 21. 
Meares. San Francisco. - - - - 214. 
Mexico. Gomez. - 178. 
. " Superior Council of Health. - - 181. 
Midnapur. Matthew. - - - - 21. 
" Gupto. - - - - 24. 
Minnesota. ..... 198. 
Mookerjee. Contai. .... 23. 
Moore. Bombay. - - - - 12. 
Moorshedabad. Shircore. - - - - 24. 
Monghyr. Hill. - - - 40. 
Morgan. Palliport Lazaretto. - - - 52. 
Murray. R. D. Chittagong. - - - 36. 
Murray. W. F. Backergunge. ... 35. 
Netherlands. Colonial Minister. - - - 188. 
" Egeling. - ... 173. 
" Van Deventer. - - - 186. 
Norway. Consul General. - - - - 191. 
" H. Vandyke Carter. - - - 82. 
Nuddea. Bensley, C. E. W. - - - 27. 
Orissa. Roy. - - - - - 39. 
Oudh. Walker. - - - - 15. 
Palliport Lazaretto. Morgan. - • - 52. 
Pathology of Leprosy. Vandyke Carter. - - 100. 
Patna. Goopta. .... . 39 
Peters. Treatment in India. - - - 66. 
Physicians. Royal College of (Eng). - - - 226. 
Picachy. Purneah. - - - . 31. 
Poona. Sassoon Infirm Asylum. • - - 53. 
Poor Houses, and Asylums. India. - - 60. 
Prevention by Segregation. Carter. - - - 82 101. 
Purneah. Picachy. - - - - 31. 
Questions addressed to Foreign Governments. - 6-102-134, PAGE 
Reports from Agra Leper Asylum. - - - 60. 
" " Ahmedabad Hospital. - - 55. 
" " Almora Leper Asylum. - - - 58. 
" " American Dermat. Association. - 197. 
" " Amritsar Asylum. - 63. 
" " Amsterdam. Van Deventer. - - 186. 
" " Asylums. .... 50-65. 
" " Backergunge. - 35. 
" " Barbadoes. - 229. 
" " Barcelona. ... 194, 
" " Bankoora. - 20. 
" *' Bankoora Jail. ... 57-78* 
" " Barrh. ... . - 40. 
" " Beehar Cooch. - - - 41. 
" " Bengal. - - - - 14. 
" " Bombay. Darmshala Asylum. - 53. 
" " Bombay Jeejeebhoy Hospital. - - 54. 
" " Bombay. Dr. Moore. - - 12. 
" " British India. - - - - 9-101. 
" " New Brunswick. Graham. - - 157. 
" " New* Brunswick. Smith. . - 154. 
" " New Brunsw ick. Tache. - - 135. 
" " Calcutta. Ghose. - - - 14. 
" " Calcutta Leper Asylum. - - 55. 
" " San Francisco. - - - - 214. 
" " Canada. - 135-157. 
" " Canary Islands. - 158. 
" " Vandyke Carter. Cases. - - 72. 
" " Vandyke Carter. Norway (1884). - - 82. 
" " Vandyke Carter. Pathology of Leprosy. - 100. 
" " Vandyke Carter. Prevention by Segregation. 82-101. 
" " Ceylon. - - - - 161. 
" " Chili. - . - - 168. 
" " Chittagong. .... 36. 
" " Chumparum. - - - 34. 
" " College of Physicians, (Eng). - - 226. 
" " Contagion. Dr* White. - - 219. 
" " Contai. - - - - 23. 
" " Cooch Behar. - - - 41. 
" Cuttack. - - - - 37, 
244 PAGE 
Reports from Dacca .... 36. 
" " Darmshala Asjdum. 53* 
" " Dehra Ddn Leper Asylum. - - 59. 
" " Dougall's treatment. - 75. 
" " Duiagepur. ... 34, 
" " Dumka. - - - 26. 
" " France. Academy of Medicine. - 168. 
" " Ghattai. - - - - 22. 
" " Guatemala. - 173. 
" " Gurbetta. - - - - 23. 
" " Holland. - 176. 
" " Hongkong. - - - 177. 
" " Hoognly. - - - - 16. 
" " Hospitals, Asylums, etc. India. - - 50-65* 
" " Illinois. . . . . 198. 
" " Iowa. - - - . 198. 
" " Japan. - - - 217. 
" " Jeejeebhoy Hospital. - - - 54. 
" " Jessore. .... 35. 
" " Jullundar Asylum. - - - 62. 
" " Julpaiguru. - 29. 
" " Kangra Asylum. - - - 61. 
" Kumaun. - 78 
" " Madras Leper Hospital. - - 50. 
" " Massachusetts. - - - - 205. 
" " Mexico. - - - 178-181. 
" " Midnapur. ... 21-24. 
" " Minnesota. - 198. 
" " Moorshedabad. • - - - 24. 
• " " Monghyr. ... 40. 
. " " Netherlands. ... 176-188. 
" " Norway. - 82-191. 
" " Nuddea, *- - - - 27. 
. ;; ^4 Orissa. .... 39, 
" " Oudh. .... 15, 
" " Palliport Lazaretto. ... 52. 
" " Patna. ... . . 39, 
* " " Peters, treatment in India. - - 66, 
• " " Poona. Sassoon Infirm Asylum. - 53. 
" " Poor Houses, and Asylums. India, - , 60, 
245 246 
PAGE 
Reports from Purneah. - - - - 81. 
" " Rajshahye. - - - - 28. 
" " Ratnagiri Hospital. - - - 52. 
" " Rawalpindi Asylum. - - - 64. 
" " Rungpur. - - - • 32. 
" " Ruthgora. * - 22. 
" " Sabathu Asylum. ... 65. 
" " Sandwich Islands. - - - 218. 
" " Sassoon Infirm Asylum. - - . 53. 
" " Savantvadi Hospital. - - 54. 
" " Serampore. - - - 2d 
" " Sialkot Asylum. ... 64. 
" " Siam. - - - - 193. 
" " Spain. - - - - 194. 
" " Treatment of Leprosy in India. - - 66-81. 
" " Treatment of Leprosy in Bankoora Jail. - 78. 
" " Trichinopoly. Leper Hospital. - - 51. 
" " Umballa Asylum. - - - 61. 
Sabathu Asylum. - - - - - 65. 
Sandwich Islands. ... 209, 218, 220. 
Sassoon Infirm Asylum. . . . . 53. 
Savantvadi Hospital. - - ... 54, 
Sein. Gurbetta. - - - - 23. 
Serampore. Greene. - 20. 
Shircore. Moorshedabad. - 24. 
Sialkot Asylum. ... . . 64, 
Siam. Kurtzhalss. .... 193, 
Smith A. C. Canada. - 154. 
Spain. Faculty of Barcelona. - - - 194. 
Stewart. Cuttack. - - - - 37. 
Thompson. Madras Leper Hospital. - - 50. 
Tracadie. Graham. - - • • 157. 
" Smith. - 154. 
" Tach6. - - - - - 135. 
Treatment of Leprosy. India. - - • 66-81. 
Trichinopoly Hospital, Canney. - - - 51, 
Torrens. Canary Islands. - - - 158. 
Umballa Asylum. - - » r 61, PAGE 
Valiadores. Guatemala. ... 173, 
Webber. Duiagepur. - 34. 
White. Contagion of Leprosy. - - - 219. 
Wright. Jessore. - - - - - 35. 
Yamamoto Dr. K. Japan. ... 217. 
Zaheerudeen. Barrh. .... 40, 
247 
DAILY BULLETIN STEAM PRINT, HONOLULU, H. I.