CHAPTER 1: THE INCREASE IN LEPROSY

RUSSIA  BOKHARA   NORWAY  ICELAND   THE WEST INDIES  JAPAN  THE GRECIAN ARCHIPELAGO, TURKEY, AND SYRIA  EGYPT  THE UNITED STATES  THE SANDWICH ISLANDS  VISIT TO KALIHI  THE MAURITIUS  MADAGASCAR   CANADA  UNITED STATES OF COLOMBIA  BRITISH GUIANA  DUTCH GUIANA  VENEZUELA   AUSTRALASIA  OCEANA  NEW CALEDONIA  FRANCE  SPAIN  THE UNITED KINGDOM  SOUTH AFRICA  INDIA  BURMA  CEYLON, TONQUIN

THE awakening of public interest in the leprosy question is due to the accumulation of evidence from nearly all parts of the world, showing that this fearful scourge, for reasons which are now being investigated, has greatly increased, and is still increasing.

At a dinner given at the Hotel Metropole, January, 1890, in aid of the National Leprosy Fund, at which the Prince of Wales presided, Sir Andrew Clark said that, "after making due allowances for the scare and disturbance which had been occasioned, there remained the obvious and indisputable fact that leprosy was a real question. He could produce overwhelming testimony of this fact, and the evidence was conclusive not only that leprosy did exist in larger measure in recent years, but that new germ centres were springing up in various quarters, and the old centres were widening. Before England and the civilised world there was looming a condition of affairs which might by growth threaten civilisation"

Sir Morell Mackenzie, in an article entitled "The Dreadful Revival of Leprosy," which appeared in the Nineteenth Century for December, 1889, after referring to, its diffusion in Europe and America, says :—" In almost every other quarter of the globe leprosy is rife at present, and wherever it exists it seems to be slowly but surely extending its ravages. It is impossible to estimate even approximately the total number of lepers now dying by inches throughout the world, but it is certain they must be counted by millions. It cannot be comforting to the pride of England —‘the august Mother of Nations ‘—to reflect that a very large portion of these wretched sufferers is to be found amongst her own subjects."

Dr. A. M. Brown, in his comments on "Leprosy in its Contagio-Syphilitic and Vaccinal Aspects," says, page 6 :—"From all that we can learn, leprosy is now alarmingly on the increase, particularly in some of our Colonial dependencies, and the fact has been causing much anxiety in later years."

The actual number of lepers throughout the world is far more than is stated in official statistics; for all authorities agree that there are cases, in some countries very numerous, which have never been reported, "the patient and his friends" (in the words of Dr. Charles W. Allen) "knowing with what horror the public regards the disease, naturally shunning publicity, and the physician humanely guarding his secret." From personal inquiries in many countries, particularly in Ceylon, Hawaii, South Africa, British Guiana, Venezuela, and the West Indies, I can fully confirm Dr. Allen’s conclusion. In Hawaii leper-hunting is a dangerous business, as many of these unfortunate beings consider death preferable to the best managed lazaretto, where, besides loss of freedom and the companionship of fond relatives, they are obliged to dwell amidst the most repulsive and saddening surroundings. While on a visit to the General Hospital, Honolulu, my attention was called to a police officer, Kealioha Mani, who was lying severely, and probably fatally, wounded by a leper whom he was endeavouring to arrest. A short time ago a party of lepers armed themselves with five new Winchester rifles, and fired upon the police sent in pursuit. The love of freedom burns as brightly in these afflicted people as in their more fortunate countrymen.

In an article on leprosy in Hawaii, in the Occidental Medical Times, April, 1889, Dr. F. B. Sutliff, Sacramento, California, who spent four years as Government Physician at Wailuku, on the island of Maui, observes:— "The work of segregation has at no time been faithfully carried out. A large number of milder cases are not disturbed at all, and a good many others have been permitted to go free because of some influence, political or otherwise, that they may have possessed. . . . It is seldom that a leper desires to go away from his home to an hospital, and the study of his life after he knows himself to be a leper is how to live with his friends and keep out of the way of those whose business it is to know all about him. I never before saw a place where the people can hide so easily……….They are quick to take alarm, and a look from the Government Physician, an inquiry concerning their name, is enough to cause them to change their residence at once." Dr. Sutliff says he has every reason to believe that there are at least four lepers not reported for every one that is.*

*Dr. L. Roussel, Government Medical Officer, in his report dated 30th October, 1888, Port Mathurin, Mauritius, says, "It is seldom lepers come to the Dispensary for treatment. Most of them hide themselves in the mountains, and do not like to move about in public."

Dr. H. S. Orme, President of the State Board of Health, California, in his instructive treatise on Leprosy, says, "I have no doubt that the practice of secreting lepers is general throughout the world, wherever the disease prevails; and it is not difficult, in an early stage, for lepers to evade the authorities and go about their usual business."

The largest number of lepers segregated in any one year was in 1873, when the numbers received at the leper settlement, Molokai, according to the official reports, was 487, for several years previous to which arm-to-arm vaccination has been prosecuted with great and unparalleled energy. The destructive re sults of this misguided policy are everywhere manifest for those who are not too prejudiced to see what is plainly before them.

RUSSIA.

Leprosy is reported to be increasing in Russia with startling rapidity. A St. Petersburg correspondent of the London Standard, January 18, 1891, says:—"The Town Council of Riga, aroused by the rapid spread of leprosy in the neighbourhood, has voted a sum of nearly six thousand roubles for the establishment of an asylum and hospital, which it is hoped will be ready to be opened in Augusta In 1887, Dr. Bergmann discovered thirty-seven cases in the town, and twenty-one in the environs. There are now over one hundred. In and around Dorpat, where the disease has attained alarming proportions, the late Professor Von Wahl strongly urged the necessity of leper colonies, such a system of compulsory isolation being in conformity with the provisions of the existing, but unenforced, law of Livonia."

As to the prevalence of "prokaza," or leprosy, in Russia, Dr. O. Petersen and Professor Munch have collected eight hundred and seventeen cases, which, however, must be considered far below the actual number. The former observer has noted forty-three cases from the records of the St. Petersburg hospitals in the last sixteen years.

Archdeacon Wright in his instructive work, "Leprosy an Imperial Danger," says that leprosy has increased so much of late in the Russian provinces of the Baltic that last year a "Society for Combating Leprosy" was founded at Dorpat, under the presidency of Professor Wahl, but otherwise composed entirely of lay members. Dr. Hellat, of Dorpat, travelled through the district, and showed that the reports made to the Government were very imperfect. In Livonia, where official statistics reported 108 cases, he found 276. In Courland he discovered 76 cases, and in Esthonia, 26. From other sources I hear that in the neighbourhood of Dorpat the lepers number as many as 17 per 100, and another report says that in certain districts 10 per cent of the population are affected. From more recent reports (May, 1892) I learn that the Town Council of Riga, alarmed by the ever-increasing proportions attained by the fearful malady, have just erected a leper hospital, at a cost of 6o,ooo roubles, which already contains 98 authenticated cases. The British Consul at Riga, in his report for 1891, says:—" It is difficult to discover the victims of this dire malady, as their relations and friends hide them from the sanitary inspectors."

In a communication from Dr. P. Hellat to Dr. P. S. Abraham on "Leprosy in the Baltic Provinces," dated 10th October, 1891, St. Petersburg, Mochovaia, 44, the writer says :—" My observations, continued for three consecutive years, gave the astonishing result that leprosy was very widely spread in the Baltic provinces; certainly considerably more than we formerly thought ourselves justified in believing. The number of lepers in certain districts is as much as 2 per cent, of the population. Furthermore, the investigation showed that the disease was steadily on the increase."—Journal of the Leprosy Investigation Committee, No. 4, December, 1891, pg. 7.

BOKHARA.

The London Daily Chronicle of October 29th, 1891, contains the following (per Reuter’s telegram):--

"St. Petersburg, October 27th.—The Emir of Bokhara has had several consultations of late with Russian medical men concerning the prevalence of leprosy in his dominions, and especially in the north-eastern quarter of the town of Bokhara, called Gonzari Pissiane, which spot may indeed be considered as the hotbed of leprosy in Central Asia. The lepers are allowed to lead an independent life in this quarter; they are allowed to contract marriages, and no supervision, whether medical or otherwise, is exercised over them. It has resulted from the advice tendered him at these consultations that the Emir has decided upon the foundation of a special hospital for the lepers, at which they will be treated by specialists in their disease."

NORWAY.

The present writer has been under the impression that leprosy had diminished in Norway, the diminution being generally admitted to be due to the segregation of lepers in the hospitals at Troudhjem, Molde, and Bergen; but Dr. Vandyke Carter, who has closely investigated the subject, considers that :—" 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 twenty-five years ago."—British Medical Journal, Nov. 28th, 1885, p. 1048.

ICELAND.

The Rev. W. T. M’Corrnick, in a lecture delivered at Brighton, says:—" Before leaving, I was enabled to gain some details respecting leprosy, which is of a bad kind, and indigenous to the country, from Mr. Patterson, the British Consul, to whom Archdeacon Wright had written for information when publishing his book on this disease, and also Dr. Scheving. I learned here that in the year 1800 there were 150 cases out of a population of 50,000, but that now, out of a population of 72,000, the numbers had decreased to 25. I must state, however, that on further inquiries from an older and more experienced doctor near Laugardalir (Gudmunson, I think, was the name) I was told that the disease was increasing, and that one in every thousand was a sufferer from this hideous complaint. There are no hospitals for leprosy in Iceland, though Dr. Henderson, who travelled through the island in 1814, states that there were four then in existence.—Journal of the Leprosy Investigation Committee, No. 4, December, 1891, pp. 69, 70.

THE WEST INDIES.

During my visits to the Virgin Islands, the Leeward and Windward Islands, and British Guiana, 1888-89, I had opportunity of conversing with intelligent residents, including governors, medical practitioners, superintendents of leper hospitals, magistrates, prison chaplains, editors of newspapers; and the general opinion was that leprosy was largely on the increase. In some islands, such as Jamaica, St. Kitts, and Trinidad, there are leper communities, which are gradually increasing; and appeals are frequently made in the Colonial Press for their segregation in hospitals.

In a dispatch to the Colonial Secretary, Dr. R. Hall Bakewell, Vaccinator-General, Trinidad, said : —" The very great increase of leprosy in this island, particularly among persons in easy circumstances, is the subject of general remark, and although we have no statistical evidence of the fact, yet it seems admitted on all hands."—Page 7, Compendium of "Extracts from Report and Returns" in the "Royal Gazette," Trinidad, March 1st, 1871.

On the 22nd January, 1889, I visited the lazaretto at Barbados, a crowded institution. A new ward was then in course of construction, to accommodate 32 more patients; but the applications from the single parish of St. Michael were greater than the extra beds to be provided. I may mention that the island of Barbados comprises thirteen parishes, with a total population of about 180,000 of which St. Michael’s contains about a sixth; and it is estimated that 150 to 200 more beds ought to be provided under the present system of voluntary segregation. If the segregation, which includes only the leprous poor and pauper class, were compulsory, as some now demand, the alarming spread of the disease, which is endemic in all the islands, would be yet more fully exhibited.

The Official Gazette, Barbados, May 5th, 1890, p. 524, says :—"With a daily average of 104 there have been 16 admissions, 3 discharges, and 4 deaths. The Poor Law Inspector, Mr. C. Hutson, says: — "Considering the overcrowding of the wards, it is, I think, wonderful that we keep so clean."

The census returns from Barbados show that while the population during the ten years, 1871 - 81, had only augmented 6 per cent., the lepers had multiplied 25 per cent.

According to the Surgeon - General’s report of hospitals in Trinidad for i88o, No. 41, p. 38, the number of patients in the Leper Asylum on June 30, 1880, was 124.

The report for 1888, Trinidad Royal Gazette, p. 1116, says :—" The admissions have been limited to the amount of accommodation, and there were fourteen lepers at the end of the year in the Colonial hospitals, awaiting vacancies for admission to the Asylum."

The Asylum (at Mucurapo, Port of Spain, Trinidad), which I visited in February, 1889, contained at that time 180 patients (under the medical superintendence of Dr. Bevan Rake), who are admirably cared for by the French Dominican Sisters. Every bed is occupied. In his report to the Surgeon-General for 1887, Dr. Rake says:—" The new infirmary at the Asylum was opened in August last, and was quickly filled, 19 patients being admitted on the 19th, and nine more on the 25th. Since then it has been constantly full."

I was informed by the lady superintendent that a new ward was, to be built at once, to contain 30 additional beds. There were then, she said, fourteen lepers in the Colonial (Port of Spain) Hospital awaiting vacancies for admission to the asylum.

In the last report on leprosy in Trinidad, dated March 1st, 1891, by Dr. W. V. M. Koch, acting Medical Superintendent, it is stated (p. 65) that the new infirmary ward, which was finished at the end of 1889, and occupied early in 1890, has been full all the year round. There was a rush of patients to fill it.

The Trinidad Leprosy Report for 1890 (p. 31) says that during the year a new ward containing 30 beds has been opened. The asylum contains 210 inmates, "every bed being occupied."

Dr. Bevan Rake says :—" There is, I fear, little doubt that the disease is increasing in Trinidad as in other tropical countries."—Papers on Leprosy, Trinidad, p. 34.

In an article entitled the "Dreadful Revival of Leprosy," in the San Fernando Gazette, Isle of Trinidad, 22nd February, 1890, the writer says :—" It may not be generally known that as far back as 1805 there were only three lepers in Trinidad; eight years later there were 73 out of a population of 32,000. Twelve years later, when an attempt was made to segregate them upon a small adjacent island, it was found that these afflicted persons had increased so rapidly that the scheme had to be abandoned. In 1878 there were 860 out of a population of 120,000, and later statistics show that the number of lepers was increasing four times as rapidly as the population." The writer arraigns the authorities for their supineness, and urgently calls upon them to take the necessary steps to arrest the progress of this fearful disease.

In a leading article in the St. Christopher Gazette (of St. Kitts), the 17th May, 1889, entitled, "The most pressing question in the Colony," the writer quotes Dr. Boon’s last quarterly report, which (he says) "clearly and forcibly showed the Government the enormous increase in our leper population during the last six years." Dr. Boon, who held the position of Acting Government Analyser of Vital Statistics, says : —" There is one subject to which I would specially call the attention of the Government, and that is the necessity of legislation with regard to lepers. I am satisfied that the disease is increasing rapidly in this island (St. Kitts)."

In the Lazaretto, No. 11, a paper published in the West Indies, the editor asserts that a careful census carried out by medical officers would demonstrate that St. Kitts and Nevis contain more lepers per thousand of the population than any other British possession. He also considers that the disease has increased in Antigua, and there are no fewer than 300 lepers in the Leeward Islands. The Lazaretto, No. 21, for April 20th, 1891, estimates the number of lepers in the two islands of St. Kitts and Nevis at 200. In 1871 Dr. Munro discovered, by a personal census, that there were 72 lepers at St. Kitts, a number which has now increased to 135, or at the rate of 90 per cent. in twenty years. To accommodate the growing community of lepers, a large lazaretto has recently been built at’ Sandy Point, ten miles from Basse Terre, St. Kitts, which already contains eighty inmates. The British Medical Journal for June 20th, 1891, says that a petition was lately sent to the Governor, Sir W. F. Haynes-Smith, with the request that it might be sent to the Queen. Amongst other things it states that leprosy is most prevalent in these islands, and that the number of persons afflicted with it is rapidly increasing.

The London Daily Graphic for August 15th, 1891, publishes the following:—" Sir Morell Mackenzie writes—‘ I beg to enclose a copy of a letter recently received by Dr. Munro, formerly medical officer of St. Kitts, West Indies, which shows conclusively that leprosy is extending in that colony.’

"The letter from Dr. Boon, referred to by Sir Morell, runs as follows :—‘In your time I believe there were about fifty lepers in St. Kitts; at present there are 120 known lepers, and I think there are a good many more that are kept hidden from the medical men. I am at present getting as complete a list as possible of the lepers here. One thing is very noticeable in Nevis, namely, the way in which the leprosy spreads in each neighbourhood from single cases. It is not easily traced in St. Kitts, as the people there do not own land like the Nevis people, and are consequently more nomadic. One thing has struck me very much, and that is the number of shop-keepers that have contracted the disease.’

"We have also received a-letter from Dr. Boon, who says :—‘The enclosed photograph of mendicant lepers, subscribed for by a few gentlemen of this island for the purpose of forwarding to you for publication in the Daily Graphic, will give a slight idea of the risks by contagion to which the population of this colony is daily subjected. Leprosy has attacked people of all conditions in the West Indies. A few years ago a newly-appointed inspector of police enforced the local ‘Vagrant Act,’ and prevented the squads of mendicant lepers from perambulating the town, begging from house to house, and importuning people in the streets. Through the action of the then President of the Island, the inspector was forbidden by the Governor to interfere in any way with these lepers. The fact that a member of the former gentleman’s family was afflicted with this disease may have had something to do with his action in the matter. We count among our lepers (other than mendicants) bakers, butchers, salesmen in groceries and provision shops, fishermen, printers, editors, circulating - library keepers, shopkeepers, planters, agricultural labourers, and carpenters. In a lodging-house kept by a leper, members of the Bar lodged when on circuit, and slept on the same bed used by the leper when he had no lodgers. Another leper kept a creche, and tended about twenty infants at a tithe in his room for over ten years.’"

In the report of the Blue Book of St. Vincent, British West Indies, 1890, the Acting Administrator observes:— "It is greatly feared that leprosy, which has already proved so great a scourge to some of our colonial possessions, will become a serious trouble in St. Vincent.

Our administrator of the islands, Mr. Irwin C. Maling, reports to the Colonial Office that the disease, though perhaps slowly, is surely on the increase; and though the average of patients treated at the Leper Asylum is only 15, there are many more at large. No law exists to compel those afflicted with the disease to go to the asylum and receive proper medical attention, but the subject is one which will receive the early attention of the Local Government."

On June 2nd, 1890, Mr. Gourley, M.P., called the attention of the Under-Secretary of State for the Colonies to the considerable population of lepers in the West Indies, which, he said, was daily increasing. Sir W. F. Haynes Smith, of the Leeward Islands, who informed me in 1889 that leprosy was seriously on the increase in the West Indies, issued an address to the Federal Council in April, 1891, in which he quotes the opinion of the medical profession that the disease has greatly increased, and that the only satisfactory explanation of the spread of the disease is that under certain conditions it is communicable and contagious. Sir William Robinson, Governor of Trinidad, writing to the Secretary of State from Government House, 9th May, 1889, says :—" After fifteen years’ residence in the West Indies, I can fully corroborate Dr. Rake’s statement that leprosy is on the increase, and I am not surprised at it."—Papers on Leprosy, Trinidad, p. 35.

In the report of the superintending medical officer of Jamaica, dated July, 1891, it is stated that 420 cases of leprosy in the island are known to the district medical officers, but it is conjectured that a good many living in unfrequented districts are not reported, and that some cases in families of the better classes are not to be found in these returns. The actual number is estimated at 450, or one in 1378 of the present population of the island, reckoned at 620,000. This is a decidedly low estimate. A new ward, capable of accommodating forty beds, has just been made ready for the reception of these unfortunate patients.

A communication from Dr. N. Lacary, physician to the lepers in the French Antilles, dated Basse-Terre, Guadaloupe, January 16th, 1892, and sent by request of the chief of the Sanitary Department at Guadaloupe, in reply to an inquiry for the statistics in respect to leprosy, states that it is impossible to report with accuracy the number of persons known to be more or less subject to leprosy throughout the various districts. The island of La Disirade, in which the Lazar-house is situated, may afford some. exact figures, and contains one hundred diseased (leprous) persons from Guadaloupe and its dependencies, and from Martinique. The lepers frequently secrete themselves, and it is impossible to give the exact figures of those who are at large. It is recognised throughout the islands that leprosy is on the increase.

JAPAN.

As my communications to the Authorities in Japan requesting information remain unanswered, I have but few details to report. Leprosy has existed from time Immemorial in this country, and there is an old established leper settlement at the hot springs at Kusatsu, to the north of Tokio. Leprosy is reported to be increasing considerably, and according to a communication in the Liverpool Mercury, September 22nd, 1891, three leper hospital asylums have been established in Tokio during the past ten years. One of these hospitals, treated in 6 years 4249 cases, of which 3852 were those of Japanese patients. The Pioneer (Allahabad) of September 9th, 1891, reports that leprosy has spread in the Japanese villages to an alarming extent during the past few years. In one village near Toimachi, in the Gifu Ken province, every inhabitant is a leper. The Japanese Government is taking steps to look after their afflicted people.

Mr Hamilton Cartwright, in The Lancet for May 25th, 1889, states that vaccination was made compulsory in the seventh year of Meiji (1874). It will be noted therefore that the rapid diffusion of leprosy took place shortly after the introduction of the compulsory law, and has kept pace with the progress of vaccination in this community. Dr. Tamanoto, of the Imperial Japanese Navy, says that when leprosy occurs in a family it is the custom to conceal it.

The Rev. Father Vigroux, Missionary Apostolic, in an article in the Catholic Review, which also appears in the Tablet, May 14th, 1892, says that 44 patients have already been admitted to the Leper Hospital at Gotemba, Japan, founded by the late Father Testevuide. There is accommodation for as many as eighty.

THE GRECIAN ARCHIPELAGO, TURKEY, AND SYRIA.

In the Island of Samos, with a population of 42,000, there are 43 registered lepers, and many others unregistered; to segregate whom the Prince of Samos has built an asylum. In Constantinople Dr. Dujardin Beaumetz estimates that there are three thousand, some of them at large, and others in the hospitals.

In Syria lepers abound, and the most repulsive examples I ever saw were in the lazaretto at Damascus, where the supervision and accommodation was of the most wretched description. For their comforts they depended on the alms given by casual visitors. In Palestine I noticed many lepers, in the most hideous state of deformity, begging. This was in 1884. The Constantinople correspondent of the Times writes (July 31st, 1889):—" Dr. Zambaco has made a special study of leprosy, and purposes to present to the congress ‘the result of his assiduous labours on the subject. Like some others, Dr. Zambaco has come to the conviction that leprosy is non-contagious. He offers practical arguments and proofs in support of his opinion. There are in Constantinople alone upwards of 250 lepers, all of whom Dr. Zambaco has personally attended. Of these, 25 individuals only are isolated in a special locality at Scutari—the remainder are to be seen in the streets, and in contact, without any restraint, with the rest of the population. In the Islands of the Archipelago there are at Crete 8000 lepers; and at Rhodes, Cyprus, Mytilene, Tenedos, and other smaller islands, they are also numerous, and excepting in the larger ones, free in their movements. Dr. Zambaco has prepared to lay before the congress, and for publication, a most interesting work upon the subject of leprosy in the Levant, containing numerous illustrations, portraits, and biographies of patients living and dead, with accounts of curious cases of cure, non-contagion, and remarkable facts observed by him, which cannot fail to attract attention of scientific men with respect to the disease which has come so prominently before the public."— Times, August 6,1889, p. 10.

EGYPT

During my visit to Egypt in February, 1891, endeavoured to ascertain the facts as regards leprosy in that country. I called at several hospitals, and conferred with a number of officials connected with Government, but without obtaining much information. Dr. Selim Zeidan, the medical director of the General Hospital at Luxor, informed me that during the past few months five lepers had presented themselves for admission, but he was obliged to refuse them. This was due not to want of space, but to lack of funds In a communication to Dr Abraham, dated 4th Nov-1890, and published in the Journal of the Leprosy Investigation Committee, Dr Greene, of Cairo, director of the Sanitary Department, Egypt, states that the total number of cases reported is 2058, "but this does not by any means represent the whole of the lepers in Egypt, for many districts, where I have reason to suppose some exist, sent in blank returns."

THE UNITED STATES

Dr. Blanc, of New Orleans, Clinical Lecturer Dermatology at the Medical College, and Dermatologist to the New Hospitals, has had opportunities for observation. In a report to Louisiana Board of Health, May, 1889, he refers to 42 known cases of leprosy at New Orleans, twelve cases at La Fourcho, and six cases (these doubtful), at St. Martinsville; and in only a very small number could he discover the causation in heredity.

In the New York Medical Journal, July 13th, 1889, Dr. R. W. Taylor states that during the past fifteen years he has almost constantly seen from one to three lepers in the crowded wards of the hospitals on Blackwell’s Island, New York. Other authorities give similar reports of the New York hospitals.

Dr. Charles W. Allen, Dermatologist, in his article on "Leprosy" in the New York Medical Journal, March 24th, 1888, calculates the number of lepers in the United States at 150. "Unquestionably," says Dr. Prince A. Morrow, "is leprosy gaining ground in this country, and the disease prevails over more than a fourth of the habitable globe."

THE SANDWICH ISLANDS

In the Sandwich Islands leprosy is allowed to be the chief of the destructive forces which are gradually depopulating the native race of this beautiful archipelago. Its rapid increase is by far the most urgent and anxious question of the hour, and successive Medical Officers of Health seem powerless to cope with it.

In a leading article on "The Nature of Leprosy" The Lancet, July 30th, 1881, p. 186, says :—" The great Importance of the subject of the nature and mode of extension of leprosy is evident from the steady increase in certain countries into which it has been introduced. In the Sandwich Islands, for instance, the disease was unknown forty years ago, and now a tenth part of the inhabitants are lepers. In Honolulu, at one time quite free, there are not less than two hundred and fifty cases; and in the United States the number is steadily increasing."

According to the latest returns handed to me (October, 1890) by Mr. Potter, the Secretary to the Board of Health, Honolulu, 1154 lepers were segregated in Molokai, to which must be added thirty, sent from the Hospital of Suspects at Kalihi to Molokai on the 30th of the same month, while there are probably several hundred secreted by relatives in the various islands. On 31st March, 1888, the number officially reported to be at large in the various islands amounted to 644, but, efforts have been made during the past three years to capture these afflicted creatures and segregate them at Molokai.

The experiment of segregation, coupled as it is with enforced separation of relatives and friends amongst a race who are very gregarious and affectionate, is attended with great difficulties, and found impossible to carry out successfully.

A medical practitioner informed me that well-to-do lepers were not interfered with, and he gave me the names of several at large who occupied prominent positions in the island; and he observed that it was not intended to disturb them, notwithstanding the law which imposes segregation upon all lepers regardless of distinction.

Dr. J. H. Kimiball, of Honolulu, ex-President of the Board of Health, in his official report for 1890, observes:---"Some very bad and unmistakable cases are in hiding in the fastnesses of the mountains or high up in the valleys, fed and secreted by their friends, while some mild cases change their place of residence so often as to baffle the efforts of the officers of the law for their arrest."

Dr. Edward Arning reported that he had visited the remotest gulches and corners of the islands, where few white men penetrate, and had found lepers at large, including some bad cases. He suggests that it may be just-as well to leave these poor wretched creatures where they are, as they are more out of the way there than at Kakuako or Kaluapapa. Dr. John S. M’Grew, in a communication to General James de Comby, the United States Resident Minister, says :—" From political and other influences with officials of the Government, many lepers are permitted (in Hawaii) to go at large without being questioned—really dangerous cases of leprosy."

Dr. White, surgeon to the United States Navy, who visited the islands in 1882, in a report to his Government estimates the concealed cases at 3 per cent. of the population.

Mr. Dayton, the President of the Board of Health, Honolulu (an old resident in the island, who has had a wide experience in the service of the public health), was kind enough to furnish me with facts relating to the introduction, establishment, and increase of leprosy throughout Hawaii, and the steps taken to deal with it by isolation, medical treatment, and hygiene, and also with copies of official reports published by the Board of Health.

According to the same writer on the subject, leprosy was discovered in the island in 1840, but Mr. D. Meyer, Agent for the Honolulu Board of Health, in the appendix to the report presented to the Legislative Assembly of Honolulu in 1886, says it was in 1859 or 1860 that he saw the first case of the disease. That 1840 was the date of its introduction is the opinion of Dr. W. B. Emerson, ex-President of the Board Health, Honolulu,’ who, in his report published in Practitioner of April, 1890, attributes the introduction of the disease to a case reported by the Rev. D.D Baldwin, M.D., to the Minister of the Interior, may 26th, 1864. In 1863 Dr. Baldwin received reports from the deacons of his church at Lahaina with the names of 60 people who were believed to be affected with this disease. In a very few years leprosy increased to an enormous extent, and in 1868 Dr. Hutchinson reported 274 cases.

Dr. Emerson says : —" Leprosy has made fearful strides. It is not necessary to trace with precision the curve that represents the increase of leprosy in these islands from that date to the present time. It is a fearful story, and should teach us that leprosy is undoubtedly communicable."

In his report dated Molokai, March 3 1st, 1888, Mr. Meyer says :—" That the spread of this scourge in these islands has been truly fearful is known to every one here, and that it could not have spread as it has done unless it were communicable, appears to me to admit of no doubt."

To account for the appalling spread of this terrible scourge of humanity within such a short period of time, the evidence points conclusively to one prominent cause--vaccination. There is no evidence to show that leprosy increased in Hawaii until after the introduction and dissemination of the vaccine virus.

Small-pox was introduced from San Francisco in the year 1868. In that year a general vaccination took place, spring lancets being used, which the President of the Board of Health (Mr. David Dayton) informed me were difficult, if not impossible, to disinfect—the operation causing irreparable mischief. The synchronicity of the spread of leprosy with general vaccination is a matter beyond discussion, and this terrible disease soon afterwards obtained such a foothold amongst the Hawaiians that the Government made a first attempt to control it by means of segregation. Another outbreak of small-pox occurred in 1873, and yet another in 1881, both followed by general arm-to-arm vaccination and a rapid and alarming development of leprosy, as may be seen in successive reports of the Board of Health. In 1886 the then President of the Board of Health recorded his conviction, in an official report, to the effect that "to judge by the number of cases in proportion to the population, the disease (leprosy) appears to be more virulent and malignant in the Hawaiian Archipelago than elsewhere on the globe." Leprosy became then, and is now, the most pressing question in these islands.

VISIT TO KALIHI

In October, 1890, I started from Honolulu in company with Mr. C. B. Reynolds, the Chief Executive Officer of the Board of Health, to visit Kalihi, a place three miles away, where persons supposed to be tainted with leprosy were incarcerated. It consists of cottages, dispensary and recreation ground, the whole surrounded by a double wall to prevent escape, and is a dreary place of abode. There were 74 patients in the establishment, most of whom exhibited distinct traces of this loathsome malady, including some unusually bad cases. Within this enclosure was a comfortably furnished cottage which Sister Rose Gertrude had recently occupied, but had now vacated. Both the cottage and the dispensary of which this lady had the charge were in a bad state of disorder, and presented a painful contrast to rooms in the care of the Dominican Sisters at Trinidad, and in other Asylums I have visited.

The day after my visit, 31 of the inmates were taken from the Suspect Hospital to Honolulu, and thence from the King’s Wharf were forcibly deported to the living grave at Molokai, from whence no traveller returns. The scene was of the most painful description. These afflicted creatures were torn from their friends and relatives, husbands from wives, children from their parents, frantic with uncontrollable grief. Lovers were separated, their lips trembling with emotion, amidst unutterable wailings, wringing of hands in the agony of despair, and heart-breaking experiences which I shall never forget, and which the pen of a Balzac, or Victor Hugo, could only adequately describe. Mr. Reynolds said that at times it seemed more than he could stand and he did all that was possible to mitigate their sufferings. He told me that in ten days time there would be another contingent to undergo the same sorrowful experience. This goes on year after year, and will probably continue until medical men themselves turn their attention from experimental treatment to preventive measures, and themselves petition Governments to suppress the mistaken system of vaccination, which, it is admitted by the highest authorities, has been a prolific source of this terrible evil.

THE MAURITIUS.

In the Mauritius, according to Dr. Seizor, in the Progres Medical, 1886, translated by Dr. P. Abraham, and quoted in his work on leprosy, lepers of all races, including Europeans, can be counted by hundreds without difficulty.

MADAGASCAR.

The Paris correspondent of the Daily News telegraphs, August 12th, 1890, that the French Catholic missions in Madagascar have taken up the lepers there, and have built a lazar-house at Ilafy, near Antananarivo. A second hospital for 200 lepers, who are not so invalided, is at Abohivaraka, where they work in the rice marshes.

CANADA

In May, 1885, the lazaretto at Tracadie, New Brunswick, contained 21 lepers, and others were known to be at large.

The British Medical Journal, July 18th, 1891, says:— "Owing to the increase of leprosy in British Columbia, the inhabitants recently memorialised the Canadian Government, asking that some steps should be taken to check the progress of the evil. It has accordingly been resolved to found a leper colony in D’Arcy’s Island, which lies off the coast. As soon as the arrangements are complete all the lepers in the colony (most of whom are Chinamen) will be transferred to this island. Dr. F. H. Smith, the superintendent of the well-known lazaretto at Tracadie, New Brunswick, has been requested to investigate the alleged increase of leprosy in the towns of the Pacific slope of the Dominion"

UNITED STATES OF COLOMBIA.

In the consular report to the Foreign Office, sent by Mr T H Wheeler, the British Consul at Bogota, dated September 26th, 1890, I find various facts confirming previous reports as to the rapid development of this disease Referring to the number of lepers Mr Wheeler says —" A well-known physician of Bogota, the editor of the Medical Review of the city, has stated, in an article lately published in that review, that one tenth part of the inhabitants of Santander and Boyaca are lepers.  As the population of these two departments is about 1,000,000 this estimate would give 100,000 lepers in that portion of Colombia alone. The medical officer of the principal lazaretto of the country, who has travelled extensively in the departments of Santander and Boyacá, with a special view of studying the question of leprosy, estimates that they contain some 30,000 lepers I believe that both these estimates are very much exaggerated, but the number of lepers must be very great in those two departments, as I am aware from my own observations in travelling through them in 1883. Some months ago the Government of Santander endeavoured to obtain from the various municipal authorities official returns of the number of lepers in the department. Reports were sent in from about half the municipalities, giving notice of 1804 lepers, of whom 388 were living in the lazaretto of the department. But no returns were sent in from the districts known to be most infected with leprosy, and in any case, no satisfactory census upon such a subject can possibly be taken in Colombia. On the merest suspicion that anything of the sort was intended, every leper, who could possibly do so, would at once disappear, and remain hidden until it was all over, for fear of being dragged to a lazaretto and separated from his family and friends, and amongst the population, in general, there is no such dread of the disease as would lead them to give information against any lepers who might be concealed in their neighbourhood.

"Santander and Boyaca are the departments most infected with leprosy; next to these are Cundinamarca, Tolima, and Antioquia, in the order named, but a certain number of cases are to be found in all the other departments. In Cundinamarca, where the number is more easily estimated than in any other part of the country, there are said to be over 4000 cases of leprosy, and in Antioquia from 800 to 1000. In the whole Republic, there cannot, I believe, be less than 20,000 cases, and there are probably many more.

"Leprosy is most common in Colombia amongst the lowest classes, whose homes and mode of life render them liable to exposure to cold and damp, but it is by no means confined to the poorer class, as many people of wealth and position have been attacked by it."

There are two lazarettos in Colombia, one in Agua de Dios, where one consul found 520 lepers in July, 1890, the other at Contratacion, department of Santander, with 390 of these afflicted people. A Bill has recently been laid before Congress asking for an appropriation of £10,000 for the construction of a new lazaretto, but the disease has reached such proportions as to render such a sum quite inadequate to cope with the ravages of the disease. Mr. Wheeler says that it seems inevitable that leprosy should continue to spread more and more throughout the country, unless some great effort is made to arrest its progress. He remarks that in Antioquia not a single case of leprosy was known thirty years ago. Since then, the disease has spread in all directions, and the number in this town is now said to be over 800. I may add that, during the interval, vaccination has been introduced in all the Republics of South America with the usual sinister results.

Mr. Edward H. Hicks, M.R.C.S., practitioner in Bogota, says :—" The local authorities have called attention to the alarming spread of leprosy in the Republic of Colombia, South America. In districts in which the disease was formerly unknown it has appeared to spread with great rapidity. As to articles of diet, the greater number of cases occur where fish cannot be obtained in these places."—British Medical Journal, Nov. 8th, 1890.

The New York Herald, of April 10th, 1892, says:— "Reports about the spread of leprosy in the Republic of Colombia are of the most alarming character, and should receive the very serious consideration of the United States health authorities. Every district in Colombia is said to be more or less infected."

In the last annual report of the Consul-General of the United States of Colombia (1890-1) it is observed that the question of the great increase of leprosy has become a very grave one for the country. Prior to the year 1860, the numbers of the afflicted were comparatively stationary; but since that time the increase has been much more rapid, and the disease has spread to districts in which it was previously unknown, almost the whole of Colombia being now infected. Children are frequently seen in the lazarettos in a leprous state, and the mortality is exceedingly high.

Dr. Alzevedo Lima, chief medical officer, Hospital, Rio de Janeiro, says :—" Has leprosy increased in Brazil within the last years? It seems that it has, but we have no exact data to guarantee a positive affirmation. However that may be, it is no exaggeration to say that in Rio de Janeiro there are more than 300 lepers disseminated throughout the city "—Journal of the Leprosy Investigation Committee, December, 1891, p 25

The last census of Brazil returned the number of lepers at 5000, but Dr. Lutz, a lepra specialist, estimates it at 10,000 and upwards.

BRITISH GUIANA.

In January, 1889, I visited Demerara and Essequebo, British Guiana, but owing to the state of my health I was unable to visit the leper asylums at Mahaica and Gorchum. During my sojourn, the newspaper at Berbice (where the leper asylum is located) published a statement to the effect that, for want of accommodation in the asylum, lepers in the worst stages of the malady had been seen in the streets and bye-ways. In the report of the Surgeon.General of British Guiana for 1887, Dr. C. F. Castor says:— " I hear on all hands that leprosy is spreading — not only here, but all over the world—very considerably." And in a communication to the secretary of the Leprosy Committee, dated 21 November, 1891 (Journal No. 4, p. 36), Dr. observes:—" No one for a moment doubts that leprosy is spreading’ I was able to obtain only one report of a date earlier than 1887, that of the Surgeon-General for 1879, in which Dr Manguet says —" Many children are brought to me in the incipient stages the disease (leprosy)," and added that the disease was spreading.

When going over the Colonial Hospital, Georgetown, British Guiana, Dr Ferguson spoke to me of the serious increase of leprosy in the colony, and said that they were obliged at the general hospital to receive lepers for whom there was no room at the asylum He pointed out to me five lepers in one ward with other patients Dr J L Veendam, a Government medical officer, who had at that time resided sixteen years in the colony, and has medical charge of four sugar estates, assured me that leprosy was much more widely disseminated in the colony than was generally supposed, and that this was the case amongst all classes of society. Referring to a ball which was to be given that evening to Governor Haynes Smith, he added, ‘I know lepers who will mix with the gay throng this evening" Some time ago Dr Veendam medically examined all the labourers on the four estates under his charge, 250 in number, and found about 50 who were more or less tainted with leprosy.

One of the highest authorities, Dr. John D. Hillis, F.R.C.S., for ten years Medical Superintendent of the principal lazaretto in British Guiana, and who has devoted twenty years to the consideration of this important subject, says :—"To the most casual observer (in British Guiana) the increase must be apparent, irrespective of the fact that the asylums cannot be enlarged fast enough to contain the cases that are compelled, by want or the rapid advance of the fell disease, to seek admission and relief within their walls, whilst hundreds of others, it is well known, do not enter but remain outside to mingle with others or contaminate their surroundings. Not only is leprosy on the increase in the colony, but the increase has been greatest in the last decade. . . . Wherever the writer goes, he meets with lepers walking about among, and, mixing with, the people, may be in the church, or in shops. As the signs and symptoms of the disease become better known, they will perhaps be more easily recognised by the uninitiated."

In 1858, the lepers were located at the present Institution at the mouth of the Mahaica Creek, which not very long ago was enlarged to meet the ever increasing demand on its accommodation.

On 31st. December, 1859, there were only 105 inmates at the Asylum. In 1869, they had increased to 300, and the place could hold no more. Increased space was provided, and in 1889 we find, from the official reports, over 500 of these unfortunate inmates. Around this leper asylum, outside its boundaries, there are large numbers of lepers not included in these returns. Dr. Hillis states that, while the increase of the population in twenty years, between 1858 and 1878, was only 45 per cent., the increase of lepers was 160 per cent.

Dr. George Thin, in his work on "Leprosy, p. (1891), says :—" It is estimated that in 1890 the number of lepers in British Guiana was 1000, or one in 250 of the population." My own inquiries led to suppose the number was larger, as from all that could gather there were about 500 lepers in the asylums at Mahaica and Gorchum, and I saw several at the General Hospital, Georgetown, for whom there was no room in the asylum. These were by old medical residents to be far less than the total leper population.

DUTCH GUIANA

Leprosy is making rapid progress in Dutch Guiana, and a devoted priest, who has been attending to the temporal and spiritual wants of the people, was reported in October, 1890, to be dying of the disease. Bishop Walfingh, of Surinam, has recently visited Holland, with the object of raising funds to build a suitable hospital, and has met with a successful response to his benevolent appeal.

VENEZUELA.

In the early part of 1889 I visited Venezuela, pursuing my inquiries as to leprosy in Carracas, Bolivar, and other places. From all the information I could obtain I learned that its spread, though less conspicuous than in the adjoining territory of British Guiana, is making constant advance. From a report made by the United States Consul at Maracaibo, Mr. F. H. Plumacher, the American Government in 1890, I find that leprosy began to be felt as early as 1828, and in 1841 the National Government, under the direction of President Bolivar, purchased an island four miles east of Maracaibo, and erected an hospital and dwelling-houses for the accommodation of these afflicted people. In 1876 the cases had assumed alarming numbers, so as to seriously to endanger the sanitary future of the State. In the year 1890 there were 125 patients in the lazaretto, and many more at large in the city and environs, and all attempt to segregate them is thwarted by the efforts made by friends for their concealment. This increase here, as in other countries, is coincident with the extension of the practice of vaccination.

AUSTRALASIA.

Leprosy is not unknown in the Australasian colonies, and is especially noticed in a report dated 7th May, 1890, and ordered to be printed by the Legislative Assembly of New South Wales. This report was handed to me by the President of the Board of Health. From it I find that, at the close of 1889, there were 30 cases of leprosy under official cognizance.

The Lancet, of August 1st, 1891, says that the number of lepers has more than doubled during the past ten years.

Referring to the report for 1891 (which has not yet reached me) the Sydney Mail of February 20th, 1892, under the head of "Leprosy," observes :—" Those of the public who are the least disposed to alarmist views will probably regard as highly serious the statements now made public regarding leprosy in New South Wales. The statements give a great shock to the feeling of confidence based on the supposed comparative immunity of persons of European races from the attacks of this terrible disease. Of course, it has always been known that where the conditions are specially favourable to contagion, the supposed racial protection ceases to be a safeguard. But it is, nevertheless, startling to learn that of ten persons found by the Board of Health during the year to be suffering from leprosy five were natives of this colony of European descent, while four were Chinese, and one a Kanaka. At the beginning of the year there were 13 lepers under detention at the lazaretto, while those so detained at the end of the year numbered 21, of whom eight were natives of New South Wales of European descent, 11 Chinese, one Javanese, and one Kanaka. During the time the lazaret has been available there have been 31 patients, of whom one could not be detained, and nine have died."

Our colonists are becoming alarmed at the invasion of leprosy in New Zealand. The New Zealand Herald, Auckland, June 14th, 1890, in an article headed "Leprosy Among the Natives," says :—" A gentleman at Hokianga writes to a friend here—'My brother was north a few days ago on a vaccination tour at Herekino, and he reports an outbreak of leprosy at Herekino amongst the natives, several of whom died from it. Others are in a fearful state. Their fingers and toes rot off, their nose, teeth, and jaws are corroding, and their bodies are rotten. He has reported the matter to the Government. Strange to say, it got this length before we heard of it. The natives are scared, and avoid each other. Timoti Puhipi recommends the lepers being deported to the Three Kings’ Island.’"

A petition by Dr. Bakewell of Auckland, New Zealand, formerly superintendent of the Leper Asylum, Trinidad, for an inquiry into leprosy in New Zealand, has been presented to the Public Petitions Committee, and referred to the Government for consideration.

Dr. George Thin states that a school in New South Wales has been closed by order of the Minister of Public Instruction, in consequence of reports that some children in it are developing symptoms of leprosy.—Leprosy, p. 247.

OCEANA.

The Sydney Morning Herald, of March 27th, 1891, says :—" The spread of leprosy among the Pacific islanders seems to be going on steadily, judging from the following report, which we take from the Samoa Times of January 31st—’ We hear (says that journal) that leprosy has established itself at Penrhyn Island, and that there are no less than ten fully-developed cases there. The doctor of H.M.S. Cordelia, which has lately been cruising in that quarter of the Pacific, confirms the statement, and is of opinion that the disease has been brought to Penrhyn from the Hawaiian Islands by a number of refugees from the latter place. The same authority also states there is a case of undoubted leprosy at Manaheke Island. These facts strengthen the argument we have used in ourcolumns, as to the urgent desirability of steps being taken to prevent leprosy becoming an established institution in our midst.’"

NEW CALEDONIA

In the French penal colony of New Caledonia, leprosy has made its way with fearful rapidity. Previous to 1853 leprosy was unknown in the colony, but recently two leper asylums have been established. In a report on leprosy, presented to the Parliament of Victoria by the Secretary to the Board of Health, Sydney, it is stated that the Board of Health has received a communication from His Excellency the Governor of New Caledonia, M. Pardon, to the effect that the disease is extremely prevalent in that Colony, where about 500 of the native population are affected, and seven persons of European parentage, six convicts, and one child, all French, have been officially reported as suffering from the malady.

The Journal of the American Medical Association, March 22nd, 1890, says :—" Leprosy is reported to have found its way to New Caledonia, the French penal colony, and already there are hundreds of cases among the natives and convicts."

The British Medical Journal of April 25th, 1891, has the following :—" Dr. M. A. Legrand has recently published an account of the introduction of into the French convict settlement of New Caledonia which is at once interesting and instructive. In 1846, when missionaries first landed in the island, the was entirely unknown there, nor did it exist in 1853, when the French formally annexed it. In October, 1880, M. Vauvray, chief of the Health Department, sent back five negroes from the New Hebrides on the ground that they had lost their fingers and toes from leprosy. He at the same time requested the authorities to prevent the introduction of lepers into the colony. In September, 1883, M. Brassac reported that there were several cases of leprosy in the north part of the island, and suggested the establishment of a lazaretto for their reception. The authorities, however, took no steps, and in 1888, Dr. Forne, chief physician and president of the Committee of Hygiene, presented an elaborate report, in which he stated that the cases of leprosy could then be numbered by hundreds, especially in the north. But the committee adopted the ostrich-like policy familiar to such bodies, and it was not till the following year that, yielding to the force of public opinion, the executive decided to establish two leper houses, one at Pic des Morts, near the Bay of Canala, and the other in the Isle of Goats in the Noumea roads. Forty lepers were confined in the former, and twenty in the latter. In May, 1890, the total number segregated was seventy, and there had already been fifteen deaths. A third lazaretto is about to be established not far from Houailou. Though it was not until 1883 that the first cases of true leprosy among the aborigines of New Caledonia were observed, more or less legendary accounts of earlier appearances of the disease are current among them. Thus a Chinaman, covered with hideous sores, is said to have arrived in 1866 or 1867, and to have lived for several years with a native tribe, several of whom afterwards developed disease of the same nature Whatever may be the true history of the importation of leprosy, there can be little doubt that it was imported, and at the present time, according to M Legrand, it exists everywhere in New Caledonia, and has acquired a foothold in the great majority of the native tribes. Europeans have also suffered. The course of the disease appears to be more rapid than elsewhere, a fact which M. Legrand attributes to the habit which the natives have of scarifying the maculae and the tubercules, often to a considerable depth, with pieces of glass, and to their ruthless use of caustics. M. Legrand considers that these barbarous therapeutics, together with tattooing and burning with moxas, which seems to be their fashion of expressing affliction at the loss of relatives, have much to do with the spread of the disease. He explains the ravages made by the disease in virgin soil like New Caledonia by the fact that the people, not being aware ~f the danger, take no precautions against it."—Archives de Médecine Navale, February, 1891

In all the French colonies vaccination has been prosecuted with rigour, and has been followed by the increase of leprosy, just as in England’ the increase of infantile syphilis is due to arm-to-arm vaccination, as shown by the Minutes of Evidence with the third report of the Royal Commission on Vaccintion. The barbarous therapeutics, the tattooing and burning, have existed among the natives from time immemorial. Vaccination has been but recently introduced.

FRANCE.

M. Besnier, a member of the French Academy of Medicine, has reported that leprosy, far from disappearing by degrees, is spreading rapidly. Since the extension of the French colonial possessions, soldiers, sailors, traders, and missionaries, have fallen victims to it in large numbers.—British Medical Journal, October 22nd, 1887, p 919.

According to the London Evening Standard, October 26th, 1891, Dr. Besnier reports the number of lepers in Paris at 100, there being at the St. Louis Hospital eight persons afflicted with this disease.

SPAIN.

"Leprosy has been on the increase in different parts of Spain for some years past, and the extension of the disease has at last aroused the attention of the Government. On February 16th the Director - General of Beneficence and Sanitation sent a circular letter to all governors of provinces calling on them to take such steps as may seem necessary under the circumstances."—British Medical Journal, March 5th, 1892.

In a communication to the Lancet, January 16th, 1892, "On the Origin and Spread of Leprosy in Parcent, Spain," founded upon investigations by Drs. Codina and Zuriaga, Dr. George Thin introduces the following table and comments :—

"Table Showing the Cases of Leprosy in the Towns referred to in this Report.

    "There is nothing in the soil, occupation, food, or race to account for any difference in the number of lepers which are to be found in these towns respectively. It also shows that the proportion of lepers to the population of the towns is not connected with the length of time that the disease has lasted, and therefore is not in relation to the opportunities given by heredity, even if it were assumed that heredity was a cause. Parcent, which is the most striking example, shows in twenty-seven years, in a population of 150 inhabitants, 65 cases of leprosy, of whom 28 were living at the end of that period; whilst Pego, with 1200 inhabitants, and where the disease has lasted since last century, had only 20 living lepers. Pedreguer, in which we know there was leprosy in 1809, with a population of 720, had in about forty years 79 lepers, of whom 12 were living at the date of the report whilst Murla, with only 120 inhabitants, had had 14 cases in seventeen years, of whom 10 were living at the date of the report.
    "Excluding heredity as an insufficient cause of these cases, and as otherwise being discredited, the difference of the rate of increase of leprosy in these similarly situated villages is best explained by the assumption that the opportunities for contagion have been greater in some cases than in others, even if we did not have the statements which I have collected from two independent sources— namely, from the Mayor of Parcent, referred to by Dr. Zuriaga, and from Dr. Codina’s report to the Director-General at Madrid. Another sad fact comes out from a study of this table—namely, that in many of the towns the appearance of the disease is comparatively recent and that in this part of Spain leprosy is spreading. The necessity for a hospital in Parcent seems to have been realised at last, for we find that a commission visited the neighbourhood in June, I887, for the purpose of finding a site, and were uttered one by the municipal corporation free of cost."

No inquiry appears to have been made, either by Dr. Codina, Dr. Zuriaga, or Dr. Thin, as to vaccination being a possible cause, which, according to a communication to me from Senor U. Montez, the Spanish Consul in London, has been obligatory for many years. This gentleman writes (London, May 26, 1892):—" Apart from previous ordinances on the subject, the law making vaccination obligatory on the whole of Spain is dated the 28th of November, 1855." This mode of propagation, where the contaminating virus enters directly into the blood, is surely more credible than the one suggested by Dr. Thin, of contagion (simple contact), unless Dr Thin, like other pathologists, interprets the word to include inoculation and vaccination.*

* Baron, in his "Life of Jenner," vol i., p. 604, says that Mr. Allen, Secretary to Lord Holland, writing to Jenner from Madrid in 1803, observes:—"There is no country likely to receive more benefits from your labours than Spain; for, on the one hand, the mortality among children from small-pox has always been very great; and, on the other hand, the inoculation for the cow-pox has been received with the same enthusiasm here as in the rest of Europe." .. . . The result, however, was the reverse of satisfactory; the writer adding, that "the inoculation of the spurious sort has proved fatal to many children at Seville, who have fallen victims to the small-pox after they had been pronounced secure from that disease."

THE UNITED KINGDOM.

The following appears in the British Medical Journal:—" Dr. T. Colcott Fox, one of the Honorary Secretaries of the Dermatological Society, has been good enough, in reply to an inquiry, to forward for publication the following list of cases of leprosy shown to that Society since its foundation:--

"Dr Fox adds that he has also seen the following private cases since 1879:---

1. Boy from Demerara. ..  .               6. Lady from Honolulu.
2. Girl from Demerara. ...                  7. Lady from Cape Colony.
3. Man from Cape Colony.               8. Officer from Bengal.
4. Man from India. . .                        9. Man from India.
5.  Lady from Orange Free State.

"Dr. Fox adds that he has seen three cases in hospital practice, but all these have also been under the care of other physicians at other hospitals.

"Dr. Larder has now two cases in the Whitechapel Infirmary."—British Medical Journal, March 30th, 1889.

SOUTH AFRICA.

In consequence of the serious increase of leprosy following the imposition of vaccination in Cape Colony, a Select Committee was appointed by the Legislature in 1883 to take evidence as to the cause of such increase, but, strange to say, no inquiry was made, nor were any interrogatories submitted to the witnesses, as to vaccination being a possible factor in the case. Mr. T. Louw, M.P., was appointed Chairman of the Committee.

Dr. Henry Anderson Ebden, President of the Medical Board, testified that he had resided many years in India—the Punjaub, the Himalayas, Rajputana, Western India, where leprosy is prevalent, and in other parts. He has been in the Cape, consecutively, close upon 22 years, and during that time had seen a great deal of leprosy. He was sure it was on the increase.

Q.—" As you are inclined to think that the disease is contagious, do you think it dangerous to the health of other people to use food prepared by leper hands?"

"I should be sorry to see a leper cook, and I go further than that. In vaccinating, I think hardly a medical man would take vaccine lymph from the arm of a leper infant. I know it has been our practice for the last twenty years not to do so."

The Rev. Canon James Baker testified that "the increased spreading of the disease in many parts of the colony is now generally admitted. It is spreading among both the white and the coloured races, especially in places near the sea coast."

In the appendix E to this report, is a letter from Dr. Wm. R. Turner, dated Vrendenburgh, 1st Sept., 1883, in which I find the following :—" Leprosy in parts of Saldanha Bay is spreading so rapidly that, if some measures are not at once taken by the Government, all the surrounding districts will probably become infected. I know of more than twenty cases in one place alone, in every stage of the disease, and am sorry to say it is not confined to the coloured portion of the inhabitants."

The conclusion stated in the official report is "that leprosy prevails extensively in this Colony, and is steadily spreading among both white and coloured classes."

In June 11th, 1884, an Act was passed by the Legislative Assembly, Cape of Good Hope, entitled, "The Leprosy Repression Act, 1884," with the following preamble :—" Whereas the disease of leprosy is prevalent in this Colony, and has lately been spreading, and continues to spread, and it is desirable to check the extension of such disease, and, if possible, to exterminate it."

At a public meeting in Cape Town in December, 1890, Sir Gordon Sprigg said that there were between 600 and 700 lepers in Cape Colony.

In a paper read before the Epidemiological Society of London by Dr Phineas S. Abraham, p. 3, I find the following :—" In the South African Reports for 1886, a decided increase of leprosy is stated to have taken place in the districts of Alexandria, Bedford, Clanwilliam, Herschel, Malmesbury, Paarl and Stockenstran; and for 1887 the spread of the disease is reported not only from most of these districts, but also from Wynberg, Stutterheim, and Kokstadt. The majority of the medical officers speak very strongly on the subject. For example, one of them (from Alexandria) writes that ‘leprosy is certainly spreading rapidly, and unless some active and efficient measures are soon taken, it will become a matter for the most serious consideration.’ - Another (from Bedford)—’ I believe it to be considerably on the increase, and should be stringently dealt with.’ Another (from Malmesbury)—’ With reference to leprosy I cannot but repeat my statements of the last years to the effect that the disease is slowly but surely increasing, each fresh case acting as the nucleus to a more or less extended infection.’ Another (from Paarl)—’It is deplorable to see what strides it is making.’ And in 1887, ‘As for leprosy, although it is making rapid strides, there is no notice taken of it’ (i.e., by the authorities). More than one of these district surgeons, indeed, assert or imply that the Boards of Management, and others who have the power to put the Act in force, shirk the duty on the score of expense, and that the Public Health Act is to some extent a dead letter."

In consequence of the continued increase of this disease, another select Commttee of Inquiry was appointed in 1889, under the presidency of Chief Justice Sir J. H. de Villiers. In the appendix J to the Report, printed by order of the Legislative Council, pp. xiv. and xv., the Rev. Canon J. Baker, F.L.S., F.S.Sc., says :—" I entertain no doubt that leprosy is spreading in this colony at the present time. Observant and intelligent persons have assured me that they have recently met, in various parts of the colony with more cases than in previous years.

"There are many and great difficulties in getting correct information on the subject. I have known patients to be carefully concealed, and the relations of the affected do not like to be spoken to as to the mode of contraction of the disease. I have given great offence by calling attention to particular cases. I believe the number to be much greater than is known by medical practitioners, or by the Government authorities."

From the minutes of evidence it appears that Dr. H. C. Wright, district surgeon at Wynberg, being under examination, testifies as follows :—

Q. 5 "Will you state roughly the number of cases in your district? "—"About twenty; but it is impossible to state exactly. A great number of cases are concealed. I have not the slightest doubt that there are more cases than have come under my notice. There are, for instance, some cases I suspect to exist, because I am aware that leprosy is in the family, and lately some of these people have disappeared ; they are never seen, and, I believe, are hidden away."

Dr. Simons, District Surgeon of Malmesbury, was asked :—

Q. 75. "Since your appointment as District Surgeon, have you known any increase in the number of persons affected ? "—"Yes; certainly."

Q. 76. "Is the disease principally confined to coloured persons? "—"No; it is not confined to coloured persons. I know of several cases where families of white farmers are affected."

Dr. W. H. Ross, Police Surgeon in Cape Town, was asked :—

Q. 230. "During the time you were Police Surgeon in Cape Town, did you meet with many cases of leprosy?"—"Yes; in going about, I used to see about a dozen a day among the poorer classes."

The Hon. Dr. Atherstone, M.S.C., who has practised in the colony 50 years, chiefly in Graham’s Town, where he was District Surgeon for 26 years, and who has always taken a great interest in the subject, said :—

Q. 341. "I am decidedly of opinion that it (leprosy) is spreading."---July 18, 1889.

The following are Extracts from the Report of the Select Committee on the Spread of Leprosy, President, Sir J. H. de Villiers, July, 1889, p. 8:— "The result of the inquiry has been, in the first place, to establish the fact that leprosy is on the increase in the colony. Many of the District Surgeons say that, in their particular districts, there is no such increase, and others again are unable to express any opinion upon the question, but in the more populous districts of the colony, such as the Cape and the Paarl, and even in some of the outlying and less populous districts, such as Alexandria and Stockenstrom, the District Surgeons report a marked increase in the number of cases. It should be borne in mind that the victims of this loathsome disease naturally endeavour to conceal it from others, as much and as long as possible, and that many more cases are sure to exist than have come under the notice of the medical men, whose answers have been received, or whose evidence has been taken. Your committee estimate the number of lepers in the colony to be upwards of 600."

On page 12 is an extract as follows :—"The committee conclude—(1) ‘That leprosy is on the increase in this colony.’ (2.) ‘That the disease will continue to increase unless effectual measures are adopted to check it, and if possible to stamp it out."

On the 8th April, 1890, the Governor of Cape Colony and High Commissioner Sir Henry Loch laid the foundation-stone of a new leper hospital at Robben Island, which will provide 200 beds for the unfortunates stricken with a fatal and repulsive disease. A writer in the Cape Argus, May 20th, 1891, who signs himself "Epaminondas," and seems, by the character of his frequent communications, to be much concerned regarding the inadequacy of the measures undertaken to check the ravages of the scourge, concludes his letter thus— "In the cause of humanity; for the suppression of the deadly disease; for the safety of the general bulk of the inhabitants, and, last but not least, the alleviation of the afflicted, it seems to me that it is the bounden duty of the Government to meet the question face to face, and devise some means to cope with this terrible and, if unchecked, disastrous evil now pervading the Colonies, and Transkei particularly."

In the valuable Consular Reports issued by the Government of the United States I find one for June, 1887, from Consul Siler, of Cape Town, which is not without interest and instruction. Mr. Siler says, "Not until 1845 was any attempt made by government to check or -to stamp out the disease. In that year a leper asylum was established at Robben Island, seven miles from Cape Town, and, up to 1884, 744 lepers had been admitted to the institution, and comprised but a very small proportion of the leper population, as the segregation of lepers was not made compulsory. In fact, lepers mingle freely with the other citizens, and their appearance is so common that they attract little attention in the streets. At the Cape Town Fish Market I have seen lepers at work cleaning and curing fish, and the disgusting sight did not seem to deter buyers."

The rapid increase of the disease, particularly among the European population, as described in the recent reports of district surgeons, has aroused the Colonial Government to action, and a second and larger asylum is in process of construction, the present accommodation being -wholly inadequate to provide for all the afflicted applying for admission.

A correspondent writes to the Cape Argus, May 21, 1891, and, referring to the alarming increase of leprosy in South Africa, says :—"it is now two - years since the out-cry commenced, and yet, what has the Colony done for the benefit of the wretched people cursed with this insidious disease, and for the protection of their neighbours? Here, in the Transkei, nothing! It is notorious that in every magistracy in the Transkei leprosy is rife and spreading rapidly, and, sad to say, over the lepers themselves there is absolutely no restraint. They frequent the public offices and trading stations unchecked.

By their horrible hospitality, they provide lavish feasts of Kafir beer, invitations to attend the same being scattered broadcast. Fancy drinking Kafir beer, prepared and filtered by leprous hands? And this is done every month in the year!"

Under the head of "The Public Health," the South African Directory for 1891, p. 446, observes that "with a view of checking the spreading of venereal disease and leprosy, which have for some years past been reported to be phenomenally prevalent in various districts of the Colony, Acts were passed in 1884 and 1885 giving the Government powers whereby it was hoped that these disorders would eventually be stamped out." One of these is entitled, "The Leprosy Repression Act," which gives the Colonial Secretary power to forcibly remove and incarcerate any known leper in a leper asylum or hospital. This drastic measure had not then been promulgated or put in force. There are many lepers in good positions in the Colony, of both white and mixed races, whose friends would make any sacrifice rather than have them segregated with their fellow-sufferers, either in Robben Island or elsewhere. Those who advocate the forcible deportation of lepers from their friends (most of whom would willingly keep them from public observation in thinly-settled districts) can know little of the heart-breaking scenes constantly witnessed at the separation of these afflicted persons at Honolulu when about to undergo perpetual banishment to Molokai, Hawaii. Although a terribly repulsive and loathsome disease, leprosy is not communicable by simple contact. The Colonial legislature would have served the cause of the public health more effectually by directing their attention to municipal sanitation, and discouraging the practice of vaccination, which, according to the opinion of district surgeons, and the best informed authorities in South Africa, has been instrumental in largely spreading both syphilis and leprosy. It is hardly possible for a disinterested observer and inquirer to come to any other conclusion.

The Cape Town Times of March 5th, 1892, says:

"A correspondent writes to the Orange Free State Express, under date February 25: The first batch of these unfortunates (the Theba ‘Nchu contingent), twenty in number, were despatched from here on Saturday last, and probably twelve or fifteen more will leave here within a few days. The lepers are all natives, mostly Baralongs. It was hard work for the Landdrost, with the aid of the mounted police, to hunt them up. It would take too much -time to relate all the cunning (in this case excusable) devices resorted to by the families of the lepers to evade the law. It was a heartrending sight to see how mothers and children parted. It must be done, for the sake of the general safety, but it was an awful spectacle to see and hear the cries of distress, especially of the sound relations who remained behind."

Referring later to the same deportation of lepers, the Port Elizabeth Telegraph, March 12th, says—"Although the large number of fifty-four lepers have been despatched to Robben Island, it is believed that others have managed to conceal their condition from the authorities." . . . "It is a very remarkable fact that, whilst in the last census the number of lepers were returned (from this district) as four, already fifty-four have been discovered suffering from the loathsome disease of leprosy."

Dr. Alexander Abercromby, author of "Thesis on Tubercular Leprosy," writing to me from Cape Town, April 20th, 1892, says the disease is now "spreading rapidly amongst the white population and better class of people."

INDIA.

In the speech delivered at Marlborough House, London, June 17th, 1889, the Prince of Wales stated that one of the chief centres of Leprosy is India, where there are 250,000 lepers, and that our colonies contained unnumbered victims to this loathsome disease. The British Medical Journal, September 13th, 1890 (p. 639), reports that "a comparison of statistics regarding lepers during the thirty years 1851-81, shows that their number has been increasing in India at the rate of about 30,000 every ten years. During the last ten years the rate of increase is supposed to have been higher." I have before me communications from staff surgeons, medical officers of health, superintendents of leper hospitals, and medical practitioners, showing the spread of leprosy in various provinces of India, and in other countries. The Rev. G. M’Callum Bullock, of the London Mission, Almora, writing 21St August, 1889, says :—" It is the general opinion of residents, both European and native, that leprosy has increased in Kumaon during the past thirty years, and there are upwards of 1600 lepers in Kumaon alone out of a population of 1 1/8 millions."

Dr. C. T. Peters, in his report on cases of leprosy treated at Belgaum, Presidency of Bombay, dated Bombay, June, 1879, says:—"Judging from Mr. M’Corkhill’s figures, there were not less than 22.8 per cent. of the population, in the Belgaum districts alone, afflicted with some form or other of leprosy."

In a paper read before the Calcutta Microscopical Society, December, 1890, Dr. W. J. Simpson said it was certain that leprosy was on the increase, an opinion confirmed in a letter to me, dated August, 2 1st, 1889, by Dr. Chunder Ghose, Medical Superintendent of the Leper Asylum, calcutta.

The City Coroner of Bombay says that leprosy is vastly increasing in that city. The Times of India, February 21st, 1891, estimates the number of lepers at large in Bombay, at 1000. At a meeting of the Municipal Council of Bombay, reported in the Times of India, April 12th, 1889, various speakers describe the terrible state of things existing in the city. Mr. Kirkham saw lepers near the public tank dressing their terrible sores, scratching their ulcers against the iron railing of the Elphinstone High School, where the boys sat on coming out of school. Dr. Blaney said, "all over Bombay, in dark corners, in gullies where rats and bandicoots had taken their abode, these lepers were hiding themselves, thrown out by their families, to pine away neglected and forlorn."

At a meeting of the General Committee of the "Homeless Leper Relief Fund," Bombay, held at the Municipal Rooms, the President, Sir Dinshaw M. Petit, said that the hospital (which contains over 200 patients) was overcrowded, and further admissions had to be refused. Having no homes or places of refuge, lepers hang about the bazaars of the large cities in India, forced by their necessities to sell fruit or vegetables, and to expose their maimed bodies to the gaze of the public, in order to obtain a wretched living.

Referring to the newly opened Matoonga Asylum, Bombay, Mr. Commissioner Acworth writes, May 26th, 1891 :—" With accommodation for 190, I had yesterday 226 inmates, but fortunately a new ward has just been completed, and this overcrowding will temporarily cease, though only temporarily. If I had room for 500 I could fill the asylum in a week."

The Times of India, May 21st, 1892, says :—"While the Matoonga Asylum is seriously overcrowded with lepers, and there are, besides, between forty and fifty bad cases in the Byculla Leper Dhuramsala, Sir Dinshaw’s lakh of rupees and the land for the extension of the asylum lie still idle because of the deadlock between the Government and the Municipality over the police charges question. As the Government decline to budge in this matter, the Corporation, not altogether unjustifiably perhaps, refuses to undertake the responsibility of the Leper Asylum. Unless something is done to remedy this state of things, our streets will again be overrun with homeless lepers, and Mr. Acworth’s labours in the cause of these afflicted people will practically be brought to naught."

The Lahore Civil and Military Gazette, May 30th, 1891, in a graphic narrative of the suffering caused by leprosy, bearing the signature "A. H.," in the leading article column, observes :—"A great deal has been said and written on the subject of the lepers and leprosy by people who have seen and pitied the miserable condition of native lepers, who parade their affliction before the public in our streets and thoroughfares, soliciting alms from the passer-by. The majority of English ladies and gentlemen who are told such persons are lepers understand and know so little about the horrible disease that they are inclined to regard them as ordinary crippled beggars, afflicted with a disease peculiar to natives, and from which Europeans are happily exempt. This is far from being the case: leprosy seems to have obtained a terrible hold over our white brethren and sisters in India, many of whom are hiding away, alone and forgotten, in the thickly populated slums and by-lanes of our large cities. I could conduct my readers to godowns and huts where English men and women are to be found in Calcutta in a horrible condition; some in the last stage of the disease."

In a Presidential address on the "Geographical Distribution of Diseases in Southern India," delivered at the annual meeting of the South Indian and Madras branches of the British Medical Association, Surgeon-General George Bidie, M.B., C.I.E., speaking on the subject of leprosy, said :—"According to census returns the proportion of lepers amongst the population of Madras is 4.4 per 10,000, against 5.2 in Bengal, and 8.5 in Bombay; but there is reason to believe that these figures fall short of the actual extent of the disease. In Madras it is on the whole slightly more prevalent in coast districts than in inland, the ratios being 4.9 in the former, and 4.4 in the latter, per 10,000 of population. The proportion of lepers in the several districts ranges from 2.0 in Coimbatore to 10.5 in Madras city. The districts showing the highest ratios next to Madras are Nilgiris 8.0, Tanjore 7.0, and Chingleput, Malabar, and North Arcot, each 6.0 per 10,000. The disease attacks Europeans and Eurasians as well as natives, but is most common in natives. The propagation of leprosy is no doubt largely influenced by heredity, but recent observations appear to show that it is also contagious. In localities in which lepers are at large with the disease in an active state, and having open sores, there seems to be an increased tendency to fresh cases amongst the general population."—The British Medical Journal, p. 115, July 20, 1889.

BURMA.

In a communication from Mr. C. G. Bayne, the Officiating Secretary of the Chief Commissioner of Burma, to the Secretary of the Government of India, dated Rangoon, 6th December, 1889, and published in the Journal of the Leprosy Investigation Committee for February, 1891, it is said that the majority of officers questioned state distinctly that, in their opinion, leprosy is increasing in Burma. Mr. Smeaton, Commissioner of the Central Division, says : —"In the opinion of the majority of the gentlemen consulted, there are more lepers now than there were ten years ago." Mr. Norton, Deputy Commissioner of Rangoon, remarks : —" Those best qualified to form a judgment on the subject are of opinion that lepers are more numerous now than formerly." Surgeon-Major Baker and Dr. Frenchman have come to the same conclusion. Mr. Bayne observes :—" The opinion of these officers is of special value, because both of them, particularly Dr. Baker, have paid much attention to leprosy, and have much experience of it. Dr. Baker gives reasons which are based on observations of actual facts, and are not merely impressions."

CEYLON, TONQUIN

In Ceylon, as I learned by personal inquiries made in the island in January, 1891, leprosy is extending rapidly amongst the native population. The Leper Asylum at Hendala, near Colombo, one of the oldest in India, which in 1880 contained only 100 lepers, has now 208; and Dr. Meier, the resident Superintendent, does not hesitate to say that, in his opinion, the disease is steadily increasing.

There are about 200 lepers at large in the city of Colombo, and about 1800 in the island. Dr. Kynsey, the Surgeon-General for Ceylon, reported in 1885 that leprosy had decidedly increased since 1862, as the number of patients then in the asylum was 63, but had increased in 1885 to 151. Dr. Kynsey says :—"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."

In a communication to the Government of Hawaii, Dr. Kynsey remarks that leprosy is not confined to any community, but is more frequently observed among the Singhalese and Tamlins; seldom among the Eurasians, and more rarely among Europeans, and is chiefly found among the poor, ill-fed, ill-housed classes of the community. The Eurasians, I may observe, as well as the better-class Europeans, absolutely decline to be vaccinated from native lymph sources, to which the native population are obliged, reluctantly, to submit.

An Anti-Leprosy Association has recently been organised in Bengal by certain benevolent members of Hindu communities in the Presidency. Their efforts are being directed especially to ameliorate the condition of the lepers in the Santhal Parganas, forming the southern portion of Bhagalpur, a very poor district, where the people can do little to help either themselves or their afflicted neighbours.

The British Medical Journal gives an account of a leper village near Hanoi, Tonquin, where, out of a population of 400, nearly one-half are affected with leprosy. The lepers of Hanoi doubt the contagiousness of leprosy, and the chiefs of the village affirm that there has not been a single case of contagion.

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