Leprosy : summary of recent work no. 1.

Date:
1924
Catalogue details

Licence: Public Domain Mark

Credit: Leprosy : summary of recent work no. 1. Source: Wellcome Collection.

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    avoidance of contact between lepers and susceptible healthy individuals, a matter less easy of accomplishment than would appear on a super- ficial view, for it embraces several problems, such, for example, as the detection of cases in an early stage, and patients will naturally conceal the disease 1f they think that to declare it will entail forced separation from their relatives and friends. This attitude will only be overcome if they can look with a fair degree of hope towards a cure of their con- dition. Instances are given of the good effects which have resulted from measures of segregation properly carried out in various countries, such as Norway, Sweden, Iceland, Eastern Canada, etc. A most instructive contrast is afforded by Hawai. In 1865 a segregation law was passed and a settlement started at Molokoi, but the law was allowed to become a dead letter and the incidence remained little, if at all, affected. During the first 29 years of American control, with more stringent enforcement of the law, the rate per mille was reduced from 13-5 to 2-16, or less than one-sixth. Several of the British possessions are mentioned to illustrate the results of isolation and segregation when properly enforced and when carried out half-heartedly. In India the incidence rate has been reduced by half in the last 50 years, although even in 1921 only 7-7 per cent. of the known lepers were isolated ; in 1911 the figure was 4:7. A great advance in the method of dealing with the leprosy question in India will be gained if the proposal to include in the leper colonies one section for the treatment of advanced and maimed cases in hospital, another for the “cottage” treatment of earlier cases, and a third for healthy children of lepers, is brought to a successful issue. In Ceylon, where segregation is inefficiently carried out, there has been practically no improvement. Jamaica and Trinidad provide an instructive comparison. In the former segregation enforced has brought about a steady reduction, so that the incidence rate is less than half what it was 30 years ago, and “leprosy is now a rare disease.’’ In the latter, measures are ineff- ciently carried out ; compulsory segregation with insufficient accom- modation and a system which does not prevent a considerable number of cases “‘absconding’’ have resulted in a steady increase in the inci- dence rate. The establishment of a Federal Leper Colony, as suggested by the Leprosy Commission of 1919, should ameliorate these conditions. Africa, more particularly South Africa and the Tanganyika Territory, is showing some degree of improvement since the matter was seriously taken in hand; prior to that time (1921) only a small proportion of those in an advanced stage of the disease was isolated and there had been a steady increase in incidence, as in all places where measures are formulated but not enforced. The ideal methods of prophylaxis con- sist of (1) Compulsory notification of cases by medical men and house- holders; (2) Compulsory segregation; (3) Detection of early cases by periodic examinations ; (4) Prohibition to lepers of certain trades connected with food, clothing, etc. ; (5) Removal of children of leper parents as soon as possible after birth ; (6) Control of immigration. This paper is a mine of information, and should be studied by all men practising in countries where the disease occurs. Space precludes even a mention of more than a few of the points dealt with. H. Harold Scott.