4
it Has been about 125, a minute proportion of
these.being due to transfers and re-admissions.
The outgoing by disease amongst the immured
also varies, there occasionally happening brief
epidemics of erysipelas, pneumonia or diarrhoea ,
though such signs of ' hospitalism' are not, I
think, commoner an Leper-Asylums than in-other
collections of sick persons. Further details
regarding these Institutions will be found in my
earlier Report; and here I will only add that
amongst their inmates there is commonly a slight
predominance of women (319 F. to 298 M. in
1880); whilst outside, men are most numerous—
843 M. to 763 F. in 1880.
PART II.
PROBABLE EXPLANATION OF AMENDMENTS NOTED.
According to the preceding Section, in Norway
there has of late years occurred a distinct decline
in the number of Lepers, and this under opposite
conditions ; namely, on the one hand a continuous
production of new cases, and on the other a
large effacing death-rate. A third important
condition, however, intervenes ; and that is, the
complete isolation of a large proportion of the
affected persons. Other possible agents in the
amelioration noted will also be alluded to below.
In limine, I should state that the 'cure' of
Leprosy by purely medical treatment has not
practically contributed anything towards oblitera-
tion of the disease. To rely, therefore, for a
general amendment upon any of the varied
remedial measures often confidently put forward
would be to indulge in fallacies hurtful as well as
deceptive, and to encourage a kind of anticipa-
tion hitherto shown by experience to be futile.
Next, that the disease is subsiding from a
' natural' cessation of its growth seems to be
disproved by the following considerations: —
Supposing no re-production of the malady, its
decline would be much quicker than is now
happening; for with a death-rate of 10 per cent,
per annum the 2,863 cases alive in 1856 would
in the course of 7 years have been reduced about
one-half and at the end of 14 years to about 650,
and so on, till, at the end of 25 years, there would
remain only about 200 lepers, whose mean age
would not be less than 60 years—assuming the
mean age at starting to be 35 years. In reality
the rate of decline would be more rapid than
this, because the death-rate rapidly rises with
advancing years : thus the Norse Tables show
that not less than 40 per cent. of all lepers die
between 31 and 50 years of age, 17.2 per cent.
dying earlier at 21 -30 years. But the same tables
prove that there has not occurred any such rapid
diminution of the pest; there now being known
at least nine times as many lepers living as should
be, on the hypothesis of a direct dying out of
disease in the country. Moreover, that leprosy
in Norway really displays any natural tendency
to subside is disproved by the researches of Dr.
Hansen (Report of 1880, pp. 17-8), who shows
that in most of the affected districts the death-
rate is not by any means in excess of the in-
crease-rate ; the very reverse, indeed, being the
fact—which indicates that the natural tendency
of leprosy is more or less rapidly to extend.
Thirdly, the decline of disease might be at-
tributed to mitigation of various hurtful agencies,
popularly associated with its origin : e. g., to the
lessened use of a fish diet, to a less harsh and in-
sanitary mode of life, or to the extended culti-
vation of an originally noxious soil, or to some
climatic improvement. But, whilst the coast-
dwelling peasantry of Norway, in comparison
with other (not all) countries of Europe, have
admittedly long dwelt in a backward hygienic
condition, living much on fish and potatoes, in-
termarrying freely, and being subject to over-
crowding during their long winters; still, on the
other hand, it is notorious that they are an
unusually well-developed and long-lived race :
and besides, individual lepers are, as often as
others, even robust people. Generalized state-
ments, therefore, not sufficing to uphold the
view suggested, it ought to be shown when and
where hygienic improvements have had an ex-
clusive connection with the decline of leprous
disease inside limited areas, often placed wide
apart; as well as with its diminution during short
periods of time. Evidence of this kind, how-
ever, I have not met with; and on further com-
paring the conditions under which leprosy now
flourishes in other parts of the globe, I fail to
find any cogent evidence that this disease is
essentially dependent upon mal-hygienic states,
resembling those long prevalent in Norway.
Experience here (as elsewhere), rather points to
its dependence on personal conditions; for where
most abundant the disease is there most irre-
gularly distributed: thus, amidst healthy spots
in Norway there are adjoining ecclesiastical areas
with about 2,000 people (all living under closely
similar states and habits), where the number of
lepers was known to vary as much as 80, 30 and
8—these figures being now reduced respectively
to 17, 15 and 0, without any noteable change in
population : and to attribute such striking local
variations solely to widely operating agency
seems to me both rash and, in the presence of a
closer acting influence, needless. Nor to my
mind, any more satisfactory is the assumption of
some vague individual predisposition amongst
the affected.
In his report for 1875, Dr. Hansen discusses
this subject in the only suitable way, namely by
reference to examples : he remarks (p. 60) that
if mal-hygiene operated as a direct, or (through
rousing hereditary taint) as an indirect cause of
leprosy, there should before the Asylums were
erected have been proceeding a decided hygienic
improvement, the effects of which were manifest
just when the practice of isolation began; such
improvement also ought to have preceded or
attended, at least, the after course of disease ;
hereditary influence, too, then being checked,
as well as the spontaneous appearance of new
cases. But of all this there is no evidence, the
facts known tending rather to disproof. In more
detail, the districts of Tromso and Trondhjem
should present a remarkable picture of hygienic
progress : thus, during 1857-60 little or no isola-
tion and an advent of new cases in 1856-60 and
1861-65 almost identical of 352 and 361 respec-
tively—also no sign of hygienic advance; but
in 1861-65 there were sent 293 lepers into the
Asylums, and during the following 5 years the
new cases declined by 37—a number almost pre-
cisely corresponding to the estimate, which might
have been made from the prior rate of increase
proportionate to number of home-dwellers . Is it
imaginable, here, that any culture-amendment
had then suddenly culminated and found expres-
sion ? Next comes the fact that, in general,
leprosy still continues to progress at its former
ratio ; which would show that hygienic changes,