7
3. By requiring the strict isolation of
leprous subjects retained in their homes at
express wish of friends. Suitable separate
lodgment would be indispensable ; unsuitable
shelter is even now sometimes supplied.
Joining of such home-isolation with more
public measures should not be overlooked ;
for to it experience in Norway seems to point
as a means essential to complete success with-
in a moderate period of time ; and in India
it would have to be still more largely resorted
to.
For carrying out the above, in addition to
funds, legislative authority is needed to take up
the vagrant sick, to remove the sorely diseased
who is insufficiently guarded at home, and at times
to enforce continued isolation of the infected until
medical sanction of liberty be granted. Such
authoritative interference will, I am aware, be
differently regarded by many and disliked by the
masses ; yet it cannot at present be dispensed with,
and sufficient precedent exists in several British
enactments against small-pox and contagious
diseases of men and animals. Besides, as ana-
logues, special institutions already exist for the
permanently disabled, the blind and the insane ;
also, in most civilized countries, for those incur-
ably affected with cancer and consumption. At
one time, indeed, Asylums for lepers were common
all over Europe, where now the disease generally
has become eradicated ; whilst Norway still pre-
sents a number of these peculiar establishments,
adapted to modern requirements, and, as I have
tried to show, not less than formerly of decided
efficacy.
APPENDIX.
Note on the Pathology of Leprosy.—I have long
regarded this malady as one of the great chronic
infective diseases of the human race ; and such
view I hold to be confirmed by Hansen's dis-
covery that in leprous structures there is always
to be found an algoid growth—a bacterium, which
is absent from both healthy and differently dis-
eased structures. In its fresh state I once saw this
organism at Bergen (1873), and soon after at
Bombay ; and quite recently it has been repeat-
edly studied on the Continent of Europe. With
the aid of new re-agents its presence is easily
demonstrated ; and I offer the appended illustra-
tion as an original one, corresponding closely with
descriptions given of European specimens. In
June last I excised a small ' nodule' from the
arm of a leper ; and after immediate hardening
in alcohol made sections for double staining after
Ehrlich's method. All these fragments show
crowds of bacilli and several large collections of
granules (? spores), which when untinted no doubt
correspond to the " brown cells " figured as char-
acteristic in Plate XII. of my large work on
Leprosy (London, 1874) : besides, there are seen
cells and nuclei belonging to the common tissues
of the nodule.—See FIG. 1. Here the patient was
in fair health, the cutaneous eruption of several
months standing, and quiescent or slowly subsid-
ing. The minute organisms could not possibly
have been accidentally introduced ; their number
is immense, and they seem to be growing actively,
the products, doubtless, being eventually absorbed.
As contrasted with the violent symptoms attend-
ing pathogenetic bacteria of acute infections, the
little irritation, local or general, commonly attend-
ing bacillus lepræ is remarkable ; yet occasional
exacerbations of disease do occur, during which
there is fever and wide reproduction of the no-
dules ; and thus the general analogy of leprosis
to syphilis and tuberculosis becomes apparent.
European observers have found both bacilli and
spores in lymphatic glands and the blood ; also
in diseased nerve-trunks, liver, spleen and testes:
the evidence of systemic infection being then com-
plete. It is known that the organism will grow
outside the body, and there is evidence that its
germs (like those of tubercle) are freely given
off from the persons of lepers ; and by compara-
tive experiment it is further ascertained that
although general disease fail to appear, yet leprous
material inoculated in animals slowly leads to a
real—if imperfect—local reproduction of the
leprous processes taking place in man. As sys-
temic infection with a visible eruption occurs only
at prolonged and irregular intervals in him, in
the lower animals (themselves possibly less fit
subjects) these intervals may be so long as to
require a year, or more, for such outward manifest-
ation. At present, proof of the contagiousness
of leprosy is mainly inferential ; but further ex-
periments may furnish positive data, like those
now being acquired in the instance of tuberculosis,
which so nearly resembles leprosis (vide large
Work, p. 176). This similitude holds good not
only in a general clinical sense, but also as regards
the attendant parasitic organism ; and, in evi-
dence, I have drawn some figures of the bacillus
tuberculosus on the same scale as those of the
lepra-growths : see PLATE, FIG. 2. This second
specimen was taken from the lung of a consump-
tive patient, who died in the J. J. Hospital:
similar appearances have been seen in the sputa
of other phthisical patients, and they correspond
to English descriptions. The b. lepræ I find to
be usually shorter and more variable in dimen-
sions—length 1 / 16000 to 1 / 6000 in.; less bent, oftener
bulging in centre and thinning at the ends;
oftener dotted in aspect or composed of distinct
granules in linear series, the number and site of
which differ considerably. The amount of small
rods and signs of spore-production greatly exceed
what has been seen in tuberculated tissues ; yet
the general characters and processes appear much
alike in both sets of specimens. Other particular
features are shown in the drawings, made as accu-
rately as possible with the aid of a 1 / 10 in. water-
immersion lens, eye-piece B, and achromatic con-
denser of Swift.
(Signed) H. V. CARTER, M.D. (Lond.)
Bombay, November 1883."
By order of His Excellency the Right Honourable the Governor in Council,
J. NUGENT,
Secretary to Government.