( 2 )
59. The most malarious districts of the Province, those of Akyab, Kyouk
Phyoo and Sandoway, were the freest from the disease which was tolerably evenly
distributed over Pegu. It was most prevalent in the Tounghoo and Shwe-gyeen
Districts in Tenasserim ; it was not contagious. One instance was given to prove the
contrary : it was that of a man none of whose relations had been lepers, who married
a woman with tubercular leprosy, he being at the time in ignorance as to her condi-
tion, and the disease shewed itself in him within one year after his marriage. The
couple had two children before the disease shewed itself in the husband, and one
after, all of whom are healthy. On the other hand, two cases are reported in which
the husbands were lepers for years, during which time they lived with their wives,
who continued perfectly healthy. The pecuniary circumstances of these three
couples are not mentioned, but from the fact that one of the two latter couples were
Europeans, it is probable that they were sufficiently well off to afford themselves
good food.
60. Hereditary transmission is shewn in one-third of the cases investi-
gated ; in the remainder, if the statements of the patients can be believed, it origin-
ated de novo.
61. It has been thought that an exclusively fish diet tended to develop
leprosy, but this Province affords conclusive evidence to the contrary, as no people
eat more fish than the inhabitants of the sea-port towns in Arakan, and yet the
disease is very rare there, so much so that the civil medical officers of Akyab and
Kyouk Phyoo report that almost all the lepers in these two districts are natives of
India, principally of Chittagong.
62. The Arakan Division also shews that the conditions which produce
malarious fevers have no influence upon the causation of leprosy.
63. The census returns shew that the Tounghoo District has the largest
percentage of lepers, 3·15 per 1,000. These returns cannot be accepted as correct. The
writer of this report was for several years Civil Surgeon of Tounghoo, and can say
that leprosy is probably less common in that district than in any other part of
Tenasserim. The Native enumerators probably put down as leprosy a diffuse
form of psoriasis very common in Burma. How far this may have been the case
in other parts of the Province it is hard to say.
64. All medical officers here consider that poverty, diet and insufficient
food are the principal exciting causes of leprosy ; the first and last do not exist to any
great degree in Burma, the second does in most Burman households ; but improper
food, such as imperfectly cooked green vegetables productive of frequent colic and
acute dyspepsia, is common enough. Lepers, as a rule, belong to the very poorest
classes of the population, and when once the disease shews itself they become
outcastes from the community to which they belong, they shun their fellowmen, and
are reduced to live upon charity. Under these circumstances the disease progresses
rapidly. In the town of Moulmein the Civil Surgeon reports that they live in
huts near the burial-grounds, and are employed about the grave-yard. In the
villages and towns they live upon the outskirts and subsist on charity, and in the
large towns they frequently resort to theft, and thus a comparatively large number
are inmates of the Rangoon Central Jail, where a very complete trial has been
given to the treatment of the disease with gurjun oil, which has been fully reported
upon elsewhere. The deductions to be drawn from the very imperfect enquiries
made in Burma are that leprosy is not contagious ; that the principal inciting
cause is filth and improper food ; that it is transmissible from parent to offspring,
chiefly in the female line ; that it may pass over one generation, which may be
perfectly healthy, and appear in the third; that the majority of cases originate
de novo ; that malaria has no influence in causing it, and neither has a fish diet.
(True Extracts.)
G. C. KYNOCH,
Head Clerk, British Burma Secretariat,
N. C. D.—Home, Eev. & Agri. Tcpt. Press—No. 466—20-S-7C—100.