ally found in Iceland to those so prevalent in Europe during the Middle Ages. Despite the long, dark, Arctic winters, short summers, and the high winds, fog, rain, and cold during the periods corresponding to our spring and fall, the Icelander is not only contented, but is most patriotic, and seldom emigrates. Some of the houses in Reykjavik are well built and sanitary, but most of the inhabitants of this island live in damp huts, the walls of which contain but few windows, which are remarkably small. The interior, therefore, is dark and ventilation imperfect. This form of construction is followed so as to better maintain the heat during the severe, protracted cold of winter. The food is exceedingly limited in variety; bread is a rarity, and fish is the chief article of nourishment.

Leprosy was probably brought to Iceland from Norway at the end of the twelfth century, and in the sixteenth century this disease was firmly established. and wide-spread. In May, 1651, the disease was so prevalent that four leper hospitals were erected, one in each quarter of Iceland. In August, 1848, these hospitals were abolished. In 1707 an epidemic of small-pox destroyed one-third of the population and

ably acquired through the marital relations. In 43 of the 63 cases contagion was possible, but could not be demonstrated. These statistics show that heredity plays an etiological rôle, that the tubercular variety is the most common, and that more females are afflicted than in India, where the proportion is but 1 female to 4 males. It is rather surprising that the number of cases of leprosy giving a history of the disease occurring in the family is not larger in view of the stability of the population and their ability to give accurate information upon this subject as far as the sixth or seventh generation. Despite the non-separation of lepers from the community, the opinion is entertained that the disease is slowly diminishing; but, in view of the impossibility of obtaining accurate information regarding the number of cases existing in Iceland, not only in the past, but also in the present, this opinion should carry no weight. In 1896 Ehler states that the Norwegian law relating to lepers would shortly be enforced in Iceland, and in July, 1898, a leper asylum would be opened.

NORWAY.

In 1896 I visited the leper hospital in

existed in Iceland, according to Peterson. The passage of a law forbidding the marriages of lepers was followed by a great decrease in the number of cases of leprosy. In 1815 an epidemic of measles caused the death of many lepers, but 36 surviving. In 1869 the number of lepers was 48. In 1880 the number was 47, and in 1894-95 the number was 158. In 91 cases occurring in males 41 were of the tubercular, 21 of the mixed, and 29 of the anaesthetic variety. Of the 67 females observed, 32 were of the tubercular, 12 of the mixed, and 23 of the anesthetic variety. Fifty-six lepers gave a history of the disease in the family, and 63 denied its occurrence in any of their relations. Sixteen of the nonhereditary cases of leprosy were probably due to contagion, 4 of which were prob

in the hospital was in the neighborhood of 460, among which one could see examples of most of the different varieties of leprosy that have been described. The hospital was admirably arranged and the pa

tients received the best of medical care and attention. The physicians in charge were men of unusual ability, thoroughly interested in their work, which they prosecuted with zeal and energy. This institution possesses a thoroughly equipped bacteriological laboratory, and the physician in charge was remarkably well trained for this work. The fullest advantages were taken of the presence of the bacillus lepra in the diseased tissues and secretions as an aid to diagnosis. Much uncertainty existed in the minds of the Norwegian physicians

regarding the contagiousness of leprosy in 1896, but at the present time the majority, although by no means all, believe that leprosy is contagious. The most important. additions to the scientific knowledge of this subject have been made by the physicians attached to the hospitals at Bergen, Molde, and Trondjhem. The work of Hansen, of Bergen, the discoverer of the lepra bacillus and the greatest authority upon this disease, is well known, as are also the labors of Kaurin, of Molde, and Danielssen.

Norway is the only European country where leprosy is endemic, but, owing to the enforcement of segregation, this disease is rapidly disappearing. In 1897 there were probably not more than 700 cases, whereas in 1856 there were 2833 cases. It is believed that 90 per cent. of the Norwegian cases give a family history of the disease, and the statistics show that 1 per cent. of the cases are under 10 years, and 66 per cent. are from 20 to 25 years of age. Both sexes suffer about equally from leprosy, whereas in other countries the majority of those afflicted are males. In 1882 107 cases were reported cured during twenty-five years, 32 of which were not treated in hospitals.

Hansen believes that the habit of two or more sleeping in a bed, which is quite common among the peasants, is largely responsible for the spread of leprosy in Norway. He thinks that the bacillus may enter the body through wounds in the skin, and leprosy may be spread by infected clothing. Ehler states that similar conditions prevail in Iceland. Arning, of Hamburg, believes that the bacillus enters by wounds, and states that in tropical countries, where the people go unshod, the disease is apt to appear in the feet, whereas Ehler states that in Iceland the face and hands are most frequently affected, as the remaining portions of the body are usually carefully protected from wounds by clothing, necessitated by a cold climate.

DISCUSSION.

I

DR. H. W. STELWAGON: There is sometimes a considerable resemblance between syphilis and leprosy. The tubercular form of leprosy, in particular, has been confounded with syphilis, although an attentive study of the history and manifestations should forbid such an error. strongly doubt the theory of the prolonged period of invasion in leprosy. A patient may have for months an eruption so slight as not to cause medical attention. In many cases I believe that there has been a mistake in observation on the part of the patient. I doubt whether, in any instance, the stage of incubation exceeds three years. Until the discovery of Hansen's bacillus almost everyone believed leprosy to be an hereditary, and not a contagious, disease. In Vienna and Paris cases of leprosy are treated in the general hospitals and no case has been transmitted in recent years. The fact that in Philadelphia a man with leprosy served as an assistant cook for almost a year shows that the possibility is not very great. The condition in Japan and China, which countries are full of leprosy, also proves this point. In New York City the patients are not secluded and the disease does not spread. I believe that there are dietetic, climatic, and hygienic causes at the bottom of the disease, and with these factors is to be considered hereditary weakness. The case of Father Damien, of the Sandwich Islands, is the only known instance of contagion occurring in nurse, physician, or student. In a hospital in New Brunswick a diminution in the number of cases was believed to be due to improved habits of living rather than to segregation. A case of leprosy in Philadelphia is an occasion for hysterical clamor, and I see no reason why cases should be secluded to such an extent as heretofore practiced.

DR. M. B. HARTZELL: The subject of leprosy is of great and growing importance in view of our recent acquisitions in the Orient. The diagnosis in well-developed cases is not generally difficult. Even so good an authority as Cappery, however, reports one case in which the lesions closely resembled those of syphilis. We should remember also that the bacilli are not present in all the lesions. I think that, as in malaria there is an intermediary host, the same condition may exist in leprosy, and hat fish may possibly be the host. Such a conception, however, is purely speculative. The theory of the entrance of the bacillus through wounds is also speculative. I believe that the incubation period is not as long as has been supposed, and that, to a moderate degree, the disease is contagious.