AN AMERICAN LEPER. 
By D. W. MONTGOMERY, M. D., 
Prof, of Pathology and Clinician for Diseases of the Skin, Medical Depart- 
ment of the University of California; Clinician for Diseases of the 
Skin, San Francisco Polyclinic. 
[Reprinted from "Pacific Medical Journal." April, 1892. J 
The contagiousness of leprosy, and the likelihood or unlikeli- 
hood of its spread in the United States, and especially in those 
States fronting the Pacific Ocean, and in active communication 
with countries where leprosy is endemic, such as China and the 
Sandwich Islands, is exciting so much attention now, that any 
case of an American acquiring the disease in the United States 
becomes of uncommon interest. The conditions obtaining in 
this country do not seem favorable to the spread of thife disease, 
for even when imported in considerable quantity, and located 
in a fair degree of concentration, as, for instance, in the case of 
the Norwegian lepers in Minnesota, G. Armaur Hansen has found 
it does not even attack the children of leprous parents. 
Leprosy and syphilis in their dissemination, as in so many 
other of their features, form a direct contrast. Syphilis spreads 
with greatest rapidity in a country where there is commercial 
activity. In such a condition of society there is a large floating 
population, among whom husbands and wives are often separ- 
ated for considerable lengths of time, and the temptation to the 
illegitimate indulgence of desires, which are perfectly natural 
and proper in themselves, becomes very strong. For the dis- 
semination of an exceedingly virulent disease like syphilis, 
where actual contact of abraded surfaces is necessary, this wide- 
spread but transient fornication is eminently favorable. One 
can see, however, that concupiscence may be as great among a 
poor, stagnant, and over-crowded population as among a com- 
mercial people; the difference is, that in the former, lust is 
necessarily confined in a narrower circle, and this limitation, 
while unfavorable to the introduction of syphilis, or any other 
infective disease, is eminently conducive to the maintenance, 
when introduced, of a slowly inoculable disease like leprosy. 
Very interesting in the study of the spread of leprosy is the 
contrast between the social conditions in Norway and in Cali- 
fornia. " It is customary on the west coast of Norway, where 
leprosy is found, for several persons to sleep in the same bed ; 
there are, in fact, too few beds for the population. Hospitality 
s a sacred duty. If a leper makes a visit he is invited by the 
host to sleep with him; if he visits a leper, he is invited to share 2 
An American Leper. 
his bed/'f) And apparently it would be as great an insult to 
refuse to sleep with a Norwegian of the west coast, as to fail to 
accept a drink in one of our old-time mining camps. In those 
parts of Norway the peasantry is wretchedly poor, and used to 
be much poorer before the present annual harvest of travelers 
brought money into the country; and the climate is cold, induc- 
ing the people to buddle together in miserably small hovels for 
the sake of warmth. The contrast with this country could 
hardly be more striking. We have a genial climate, a well paid 
and actively employed population; new houses built of wood, 
and not very air tight, because of the absence of the necessity 
of keeping out frost; and a good, relatively cheap market, well 
supplied with meat and vegetables. And exactly in accord with 
this, although we have always a considerable number of lepers 
here, coifting principally from China, the Sandwich Islands, 
and from Mexico, the occurrence of leprosy in an American who 
has never been out of the United States is a rarity, which would 
certainly not be the case if it were nearly so contagious as is 
generally believed. Bulkley is perfectly right in asserting 
that leprosy is not a contagious disease in the ordinary accepta- 
tion of the term. (2) 
On February 29th, 1892, there died at the San Francisco Pest 
House a leper with the following history: 
B., aged forty-three; an American; was born of American 
parents in Massachusetts, and never was out of the United States 
excepting a few hours in passing from Buffalo to Detroit over 
the Canada Southern Railway. About twenty years ago he 
acquired a sore on the penis after connection with a white 
woman in Nevada State; no history of secondary symptoms 
could be elicited. He did not deny that previous to this he 
might have had frequent connection both with Chinese and In- 
dians, but he said that if so, it was a long time before, and had 
no connection with the sore. Shortly after the acquisition of 
the sore, and while still in Nevada, he had charge of a gang of 
Chinaman on the railroad. There were several Chinese prosti- 
tutes in the camp with whom he had frequent connection. He 
did not remember that any of the Chinese showed any of the 
symptoms of leprosy, but admitted that they might have had 
the disease and escaped his notice, as he did not know anything 
(x) Die .Dtiologie der Lepra (Studien ueber Lepra in Norwegen) von G. 
Armauer Hansen. Internationale Beitraege zur Wissenschaftlichen Medicin. 
Rudolph Virchow's Festschrift. 
2) See letter by L. Duncan Bulkley, New York Medical Record, March 
8th, 1892. An American Leper. 
3 
about leprosy at that time. About seven years ago he noticed 
areas of brown discoloration on the body and limbs, which were 
diagnosed and treated as syphilis by the doctors whom he con- 
sulted. His malady was first correctly interpreted by Dr. Geo. 
L. Fitch, of San Francisco, about five years ago, and about six 
months later he entered the San Francisco Pest House, where 
he remained for two years. He again entered on February 
17th, 1890, and remained till his death. 
The patient was above medium height, with a well developed 
bony skeleton. He was bald on the vertex, the remaining hair 
was brown, and rather dry looking as if not well brushed, but 
otherwise healthy. The scalp was in good condition. He had 
neither eyebrows, eyelashes, nor moustache, and the beard was 
very sparse. The disease was situated especially in the face, 
bands and forearms, and feet and legs. There were large nod- 
ules on the site of the eyebrows, and from there the disease 
shaded off upwards into the clear scalp above. The eyelids 
moved a little stiffly from the infiltration, but there was no 
lagophthalmos, as is so frequently the case in leprosy. The 
skin of the nose, and of the whole of the lower part of the face 
was very much thickened, especially the lower lip, which stood 
out stiff and useless. The patient originally had a light com- 
plexion, but when I saw him the skin of the face, hands, and 
lower part of the legs, and of the feet was a dark coppery color. 
The skin upon the lesions of the face had the silky soft appear- 
ance so often seen in patients suffering from tubercular leprosy. 
On the skin of the arms and hands, and of the legs and feet 
there were excoriations, the seat of previously existing pemphi- 
gus blebs, which appeared from time to time. The last joint of 
the ring-finger of the left hand was enlarged and stiff; the move- 
ments of the hands were not nearly so deft as formerly, but 
there was no paralysis, and no wasting of the muscles. He had 
lost appreciation of touch, and on being handled felt as if a 
substance were between the fingers of the person and his skin. 
His extremities were analgesic, and he had recently burnt his 
fingers in picking up something hot, without experiencing any 
pain. His appreciation of the sensations of heat and cold was 
not tested. There was a discoloration, such as he said consti- 
tuted the first symptoms of his malady, on the inner side of the 
left leg. It was an irregular, fairly well circumscribed, brown 
patch about the size of a silver dollar, joined by a narrow isth- 
mus to a similar patch. At the edge of this discoloration there 
was a lepra nodule, well raised above the level of the skin, and 
very dark in color. It might easily have been mistaken for a 4 
An American Leper. 
melanotic sarcoma. This nodule was cut out, and lepra bacilli 
were found in scrapings from its cut surface. Sections prepared 
for the microscope showed that its black color was owing to an 
extraordinary amount of lepra pigment. 
The eyeballs were clear, and moved normally, and the sight 
was good. The skin covering the auricles was normal, a re- 
markable circumstance considering their liability to be affected, 
and the advanced stage of the disease. The hearing was good. 
Both nares were almost completely blocked, so that he could 
scarcely breathe through them. The epithelium of the dorsum 
of the tongue was a glittering white, and the surface was marked 
off by deep furrows running in all directions, but principally 
longitudinally and transversely. This condition of the tongue 
is usually found associated with syphilis, and it was the only 
symptom I could find at all indicative of that disease. He com- 
plained he could not eat fish, because of the difficulty in detect- 
ing the bones with his tongue, so that the sense of touch was 
evidently obtunded. The voice was husky and the breathing 
difficult; in speaking he frequently had to pause to take breath, 
and at times the hospital attendants were afraid he would 
smother to death. He said he had not had any sexual desire 
since the commencement of the disease seven years before, and 
he blamed, as this class of people frequently do, the mercurial 
treatment for its extinguishment. The skin of the penis and 
scrotum was absolutely normal, but there was a small solid 
swelling in the left cord, and the left epididymis was slightly 
enlarged but of normal consistency. His mind was clear and 
his answers terse and to the point. 
As Jonathan Hutchinson is an ardent advocate of the theory 
that the virus of leprosy enters the human being with his food, 
and that fish is the most likely vehicle, we inquired, with a view 
to ascertaining the part possibly played by food as a medium of 
transmission in this case, how the hands fared in such a camp. 
He answered that the food was always good and abundant, with 
plenty of fresh meat and very little fish. 
It seems to me that this man's opportunities of contracting the 
disease were excellent, mixed up as he was in the topsy-turvy of 
a railroad camp with a people among whom leprosy is fairly 
common. 
I wish to acknowledge my indebtedness to Dr. S. J. Hunkin for 
the adroitness he displayed in obtaining many of the facts made 
use of in this article from a patient who was particularly taci- 
turn, gruff and difficult to handle.