6
any) in home-conditions ; and the figures quoted
are quite conclusive against the view that leprosy
persists only as the result of ordinary mal-hygiene
or a hurtful clime. In 1880, as previously, it is
found that in the great majority of affected dis-
tricts the death-rate of lepers lies below their
increase-rate—the exceptions being one, or at
most two, out of nine such districts ; and as
regards the other seven or eight, Dr. Hansen
remarks the death-rate is so far below the pro-
duction-rate, (viz., from 2 to 6 per cent. lower,)
that the condition of these localities would have
been most grievous had there not taken place a
large emptying of the sick thence into the Asy-
lums:—" Indeed, except in Nordfjord, everywhere
" would the actual production-rate have been
" greater than ever before, without such prior
" isolation as has been available ; and incomplete
" as this is and always has been, we may congra-
" tulate ourselves that it was practicable, and
" ought to feel grateful to those who by their
" zealous labours for the public weal have effected
" the establishment of the existing Asylums"
(p. 18).
Briefly, analysis of the official statistics proves
that the affected districts are becoming emptied
of their sick, not by excess of deaths but by
abstraction and isolation in Asylums and at home
of many affected persons. Dr. Hansen also very
reasonably adds that on the supposition of leprosy
spreading by contagion, one can readily under-
stand the disease may be subsiding generally, in
spite of a sustained production-rate ; since, conse-
quent on removal to the Asylums and on isolation
at home there must necessarily remain at large
a smaller number of contagion-bearers capable
of infecting the hitherto sound. Indeed, except
upon the hypothesis of contagion, no other expla-
nation of events seems possible.
Respecting the varying amount of disease, old
and new, which prevails in individual areas, Dr.
Hansen refers to the corresponding differences
met with in abundance of the mild (smooth) and
severe (nodular) forms of leprosis ; showing in
detail that where the worse form is commonest,
there arise the largest proportion of new cases.
Though somewhat recondite, this explanation I
regard as probably valid.
Summary of Part I I.—The amendment of public
health under notice cannot be satisfactorily ac-
counted for by reference solely to a general im-
provement in diet, dwellings, soil or climate;
nor has purely medical treatment ever proved
curative; and so far from leprosy in Norway
showing a natural tendency to subside, there is
ample evidence of a present activity equal to that
displayed by the disease 25 years ago. Some
influence might, therefore, be assigned to the
special measure of isolating lepers ; and, in point
of fact, amongst all the available data, to none
does amendment bear such definite relation—fixed
or progressive — as it does to that lessening of
lepers at liberty which results from the practice
of enforced isolation. I admit that demonstration
of such essential relationship is to be had only
through a perfect acquaintance with every detailed
instance adduced ; yet with present information,
I submit the evidence is enough to prove its
reality, and to indicate the true modus operandi
of leper-isolation as practised in Norway. More
than a single beneficial influence may, indeed, be-
at work ; but predominant is this exclusive dealing
with the individual leper as himself the source of
ill to others. So much being granted, it remains
only to add that the transmission of personal
ailment is necessarily effected either promptly by
contagion, or slowly through communication to
offspring—the intimate mode of transmission
being essentially the same in either instance ;
and here, Norwegian experience seems to indicate
the usual predominance of contagion.
PART III.
PREVENTIVE MEASURES SUITABLE FOR INDIA.
Both social and humanitarian motives would in-
culcate the systematic relief of the leprous sick,
whose malady to themselves is so grievous and
abiding and to others so offensive or even hurtful.
To all who recognise a claim thus founded, the
experience patiently and not uncostly accruing in
Norway must appear equally interesting and en-
couraging. Being scientifically acquired, the
principles hereby evolved become applicable under
conditions so widely diverse as those of Norway
and India. First, as to country and clime, there
is no reason whatever to suspect that leprosy any-
where differs in origin or nature, any more than
it differs in signs, course or consequence; and
this consideration at once disposes of pre-con-
ceivable objections to the best line of treatment
being the same in both countries named. Ana-
logy with other chronic diseases common to
Europe and the East serves to confirm this view.
Next, as to collateral circumstances, these are but
subsidiary ; only in India the people being sub-
ject, more ignorant, apathetic and prejudiced,
it is for their leaders and the ruling powers to
initiate the needful preventive measures, and to
uphold these until by spread of knowledge and
experience of good effected the public approval
becomes assured.
General treatment of the leprous as a pecu-
liarly affected class may be either ordinary or
stringent. Thus, the sick may be collected and
dealt with as ordinary hospital patients ; without,
that is, regard to prevention or future amend-
ments. Or, for permanent relief, they should be
strictly isolated from the rest of the community,
and amongst themselves the sexes kept apart—
isolation of this kind being practicable at the
homes of lepers, but better carried out in Asylums.
Evidently, this last method is the only one likely
to check and lessen disease : it has, in Norway,
proved to be beneficial in both these directions,
as well as by awakening the people to a sense of
rational self-help and a willingness to co-operate
further. Such a cogent and attractive stimulus
is much needed in India, where the foundations
of public hygiene have yet to be laid.
Segregation is practicable in three modes, either
separately or combined:—
1. By erecting plain Asylums at certain
centres, each of which would be a refuge
common to several districts ; and a place of
detention, under due management and super-
vision.
2. By founding Leper Colonies or village
communities mainly of the affected, who, while
allowed more liberty of movement, should yet
be prevented from mingling with the pea-
santry around : hence still the need of strict
supervision. Many spots would thus serve—
such as deserted forts, decayed villages, and
places now waste yet not far from other
sources of supply, or not without near re-
sources easily resuscitated.