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in Norway, where, a few years since (1856), there were two thousand cases, and which locality is the source of our supply.*

In Keith Johnstone's Map of the Geographical Distribution of Diseases, a copy of which may be found in Blythe's Dictionary of Hygiene, North America is the only one of the great divisions of the earth in which leprosy is not marked. But the disease existed here, in Canada, the Northwestern States, Louisiana, and in Mexico. In Louisiana it existed more than a century ago, being noticed in Romaine's History of Florida (1776); and in 1785 a hospital of lepers was erected in the vicinity of New Orleans, the site of which bore the name of “ The Leper's Land"-(la Terre des Lepreux)--for many years after the destruction or decay of the buildings. The disease was then common among the negroes, and was, in all probability, brought from Africa, where it has always existed. Indeed, in 1850 Dr. Joseph Jones saw a case of leprosy in Georgia, in the person of a native African. But it is a singular, if not significant fact, that in 1880 all the sixteen cases observed by Jones on Bayou La Fourche, and all the recorded cases treated in the Charity Hospital of New Orleans, were whites. Certainly there can be no question of heredity here.

Leprosy was introduced into the Province of New Brunswick, Canada, at Tracadie, near the Bay of Chaleur, in 1820. How and whence is not known. There are a few cases there now, and a leper hospital is maintained. Dr. Graham, of Toronto, visited this quarter last summer (1883), and gives the following as the result of his observations:

1. “The origin and early spread of the disease cannot be explained on the theory of hereditary transmission, although this theory may account in part for its further propagation.

2. “Although endemic influences, such as mode of life, diet, etc., may be strong predisposing elements, they are in no case the sole cause of the disease.

3. "Leprosy in Tracadie was imported from without, and finding favorable conditions, was propagated from one person to another by contagion.” [The italics are mine.-R. J. F.] -(Leprosy in New Brunswick, J. E. Graham, M.D., Montreal, 1883.)

* In Norway, in 1872, with a population of 1,756,965, there were total deaths, 29,417; from leprosy 120, or 4 per 1,000,

In the Sandwich Islands leprosy was introduced about 1843, from China, probably. In 1865 a leper hospital was established on the island of Molokai, where, at the time of Dr. Tryon's visit, eight hundred and six lepers were found. Some time in 1882 Dr. White, of the United States Navy, visited the Sandwich Islands and reported as follows:

Leprosy seems to be on the increase. To the two per cent. of the total population of 58,000, known to be affected and now under government care on the leper island of Mokolai, or 1,161, an estimate of three per cent. more is added of concealed cases, by persons who claim to have some knowledge of the subject, making a total of 2,856 cases of leprosy."

From this it appears that here we have a marked exception to the general rule of the decrease of leprosy throughout the world.

In regard to the prevalence of leprosy in Norway, Dr. Damilson, of St. George's Hospital, Bergen, reports twelve hundred cases in a population of two hundred thousand, on the coast of Norway, equal to six-tenths of one per cent. As to its decline the statistics show: 1856.....

2,113 cases. 1874.

1,832 1878..

1,681 VARIETIES OF LEPROSY.—The latest writer (Erasmus Wilson, in Quain's Dictionary of Medicine, Art, Leprosy) divides the varieties of the disease as follows: Elephantiasis (Græcorum), Elephantiasis tuberosa, and Elephantiasis anæsthetica; with a sub-variety, as Elephantiasis nodosa, or Elephantiasis mutilaus.

PATHOLOGY.-Leprosy is classed by pathologists among the “infectious granulation tumors (Virchow), three of whichtuberculosis, glanders, and leprosy—are now known to have characteristic bacilli, and the fourth-syphilis—is suspected of having such

The morbid anatomy of leprosy shows a thickening of the neurilemma of the nerves, and a separation of their febrillæ by a dense cellular deposit; and a similar cell infiltration in the leprous tubercles. This condition, although always found in leprosy, is not peculiar to that disease-being found also in bucnemia, lupus, glanders and syphills; hence, many eminent

pathologists, including Virchow and Hebra, think this condition to be merely a symptom and association, the distinguishing pathological feature of the disease remaining yet to be discovered.

BACILLUS LEPRÆ.—The “bacillus lepræ” is described as a very delicate rod, about one-half the length of a red blood disc, and one-fourth as wide as long, tapering at the ends. The rod may be thickened by several nodosities—the spores (Gradle, p. 192). They have been successfully cultivated, but all attempts to produce the disease in other animals have failed.

CAUSES.-As the disease prevails all over the world, among all races, in all climates, at all elevations above the sea level, among all classes and conditions of society, from the highestincluding kings—to the lowest, and among those subsisting upon the most varied kinds of food, it might be rightly conjectured that it has been assigned, without much satisfaction, to many different causes. Erasmus Wilson is inclined to attribute it to marsh exhalations, and after mentioning some observations looking this way, says: “The writer could multiply cases of this kind considerably, and has had the conviction forcibly borne in upon him that the cause of leprosy is miasma. No other cause is of such general distribution, suiting every climate and every part of the world unless it be such countries as have been relieved of the cause by land culture and improvement.”

MODES OF PROPAGATION.- The consideration of these may be at once reduced to two-contagion and hereditary transmission; and, in all probability, leprosy, like its congener, syphilis, may have both.

In New Brunswick, although heredity was the common mode of transmission, yet in Dr. Graham's report there are cases which cannot well be explained without calling in the aid of contagion.

Again, among the cases reported by Dr. Jones, from Louisiana, is one so marked that I cannot refrain from briefly alluding to its peculiar features.

Father Boglioli, native of Italy, aged 66, came to the United States in 1840, at the age of 26. Has had yellow fever, and been most of the time in New Orleans and Louisiana. For fourteen years was priest to Charity Hospital. He gives the following

opinion as to the origin of his disease: “In 1879, administered extreme unction to two cases of leprosy, rubbing their hands with oil, etc. Also, had attended several other cases of leprosy, in his capacity of religious adviser and pastor, in the male and female wards."-Charity Hospital, New Orleans, 1879.

Erasmus Wilson says of contagion, in speaking of the introduction of leprosy into the Sandwich Islands by Chinese emigrants in 1848, and its rapid increase, and, commenting on this significant fact, gave it as his decided opinion, “that, though leprosy was, under ordinary circumstances, non-contagious in Europe, it was probably contagious in tropical and semi-tropical countries."-(Dr. Liveing-Goulstonian Lectures, 1873, p. 92.)

The presence of a peculiar bacillus is also a strong presumptive proof of contagiousness, or leprosy must be a strange exception to its kindred: glanders, tuberculosis, etc.

But leprosy is not contagious in the ordinary acceptation of that term. It requires an absolute inoculation of pus or blood into the circulation through open vessels or abraded surfaces, and at the same time it is assumed that we must have the cachectic conditions favorable to the action of the virus.

Cohabitation is equally a cause of infection, the local conditions of absorption being the same.

* Vaccination (i. e., human, as practiced in the Sandwich Islands in 1853),” says Dr. Wood, U. S. Navy, 4th Rep. Navy Dept., 1879, “is a means of inoculating the system with leprosy.” The same author states that the dressers in the hospitals of Calcutta, and other portions of the East, positively free from hereditary disease, have in many instances developed it under circumstances connecting the inoculation with their duties. Dr. Robertson, superintendent of the leper house in the Seychelles Islands, became a leper during the period of his connection with that institution.

DIAGNOSIS.—In this branch of the subject we will first consider the various diseases with which leprosy has at times been confounded. In the Bible, the leprosy of Naaman, Gehazi and Moses was not the true disease, but leucoderma, or morphæa alba. These diseases are known as white leprosy, a disease quite prevalent at the present time in India, where, strangely enough, it is called “ Jewish leprosy.”—(Liveing, p. 146.)

Dr. Carter, in his report on leprosy, 1872), says: “White lep

rosy is everywhere found. Perhaps i person in 1,500 in the whole Bombay Presidency is affected by it.” It differs from leprosy in being essentially a local disease, and often unilateral.

Another disease confounded with leprosy, even in the Bible, is bucnemia, or Barbadoes leg. This confusion exists in modern times, perhaps, in a great degree, from the confounding Elephantiasis Græcorum and Elephantiasis Arabum. The distinction is easy, however-one has a bacillus, the other a filaria, if not as a cause, yet a constant attendant.

Leprosy has been also confounded with yaws, but only among negroes.

Syphilis is the disease with which leprosy in this country is most apt to be confounded; and I would beg any of our members residing in the northern counties of this State to narrowly watch among their patients for symptoms of secondary syphilis, especially of an unusual or abnormal kind. This request will seem pertinent and reasonable when they consider the chronic nature of leprosy and its consequent easy concealment; and also when they hear the researches made into history in this State, and the surprise of even the oldest practitioners, to find that it had prevailed, and deaths occurred from it among the people of their neighborhood, without even the suspicion of the existence of such a state of affairs.

Dr. White, of Boston, says:

“ Take my own single experience. One of the Tracadie cases escaped from the lazaretto (in New Brunswick, Canada,) twenty-five years ago, and was for a considerable time a resident of Boston, under an assumed name. He was under my charge for months at the Massachusetts General Hospital. There has died during the past year under my care one of the Louisiana lepers, from the Plaquesmines district.”—(Am. J. Med. Sci., Oct., 1882, p. 447.)

LEPROSY IN IOWA.-Last summer' I was a good deal surprised by the receipt of a request directly from Dr. Frederick Ekland, of Stockholm, Sweden, and also from him through the National Board of Health, to furnish him with details of cases of leprosy in this State. Never having heard of the existence of a case in this State, I so replied, asking him for the source of his information. Later, I received an answer, stating

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