COLONIAL SECRETARY,
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GIBRALTAR.
DR. TURNER to COLONIAL SECRETARY.
I HAVE met with only three cases of leprosy in Gibraltar during the past 27 years, and had there been other cases I think they should have come to my notice.
Two of these cases were Spaniards, and after they had been diagnosed they were excluded from Gibraltar.
The third case is somewhat remarkable. It occurred in a man who was native of Gibraltar, and who had been an inmate of the lunatic asylum, suffering from imbecility for 19 years before he became affected with leprosy.
The causation, therefore, in this case was very mysterious. The inmates of the lunatic asylum live under the most perfect hygienic and dietetic conditions, and have no communication with the outside world, except a fortnightly visit of half an hour from one or two relatives.
The patient was admitted to the asylum in 1883, became affected in 1902, was diagnosed in 1903, and died in 1906. The characteristic bacillus lepræ was found in the hypertrophied tissues of the face.
All available means were used to obviate anything like contact with other inmates of the asylum. Clothes and washing materials, feeding utensils and Patient slept in a separate dormitory, and remained apart from the others during the day. He was not allowed to handle anything
bedding were kept apart.
that would be handled subsequently by others. His washing was done separately in a separate copper.
The case seems to favour the theory that leprosy can originate de novo, yet it is true that the inmates of the lunatic asylum, prior to the occurrence of this case, had once a week a ration of dried cod fish.
WILLIAM TURNER, M.D.,
27th March, 1909.
Medical Officer, Lunatic Asylum.
EXTRACTS FROM RETURNS.
CYPRUS.
REPLY TO LIST OF QUESTIONS RESPECTING LEPROSY.
The Office of the Chief Medical Officer, Cyprus, 1st June, 1909.
1. No special grouping, cases being found with equal frequency on the littoral and inland.
2. (a) Race-no difference, Moslems and Orthodox Christians being affected practically equally in proportion to their respective population.
(b) Soil --no information.
(c) Food-it is currently believed by the Cypriots that the use of olive oil in quantity as a food results in leprosy (especially the anaesthetic variety), and in support of this it is a fact that the villages of Akanthou and Lapithos (the chief oil- producing villages of Cyprus contribute more lepers than do the other villages in proportion to population. It is a fact worthy of note that Moslems, whose religion forbids the use of pork, suffer from leprosy in practically the same proportion to population as do the pork-eating Orthodox Christians.
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Children born in the Leper Asylum are removed as soon as possible and lodged in a house in Nicosia town, where they are clothed, educated, the girls taught weaving, &c., and the boys helped to acquire knowledge of trades. There are nine
children there at present, the oldest 14 years of age, and none of them have so far shown the slightest sign of leprosy.
MALTA.
REPLIES TO QUESTIONS.
The following facts have been ascertained with regard to the 66 male lepers kept at the Leper Asylum:
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Race. All the lepers belong to the Maltese lower classes.
Heredity. Thirty cases admitted the existence of leprosy in their family history.
Food.-Forty-three patients used salt fish as one of their principal articles of food; 18 occasionally used salt fish; four never used it; and one used
Of the 30 cases with a family history of leprosy, 21 used salt fish, seven used it very rarely. occasionally, and two never used it.
Twelve female lepers are kept at the Hospital for Incurables at their own request. The following facts have been ascertained with regard to them :- Heredity-Six admitted the existence of leprosy in their families. Food-Eight used salt fish as one of their principal articles of food, whilst four never used salt fish.
Of the six female lepers with a family history of leprosy, five used salt fish.
SIR,
GAMBIA.
Lamin, April 27, 1909.
In answer to your enquiries re the occurrence of leprosy in the Protectorate,
I have the honour to forward you the following notes:-
Lepers are met with all over our Protectorate; I should think that there is at least one in every town of any size. As far as I know, the disease is not more common in one district than in another.
The nodular form of the disease is the more usual.
The natives make hardly any attempt to isolate lepers, though many under stand that the disease is contagious. A feper, as long as he is able, goes along his
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ordinary business, and lives with his family and wives, who, however, often desert him, not so much apparently from dread of the disease as on account of the loss of sexual power, which sooner or later supervenes in course of the disease.
Such a leper, however, especially if of the better classes, generally takes his food from a separate dish to other people, and does not offer to shake hands with any one without first covering his hand with his gown, but otherwise until bedridden and crippled his disease appears to be no hindrance to his ordinary social and business duties.
The natives recognise the disease as incurable, and although in the first year or two I was here a certain number came to me in hopes of some cure, I have had to tell them so often that I have none, that now I see very few lepers as patients, unless they come for some intercurrent trouble.
I have never known a case of hereditary (real or apparent) transmission of the disease, but have come across one or two cases of a wife being infected from her husband.
The connection between fish-eating and leprosy in this country obtains no proof or the reverse, as although the people near the sea probably eat more fish than elsewhere, there is a large trade all up the river in dried fish, which is one of the favourite relishes for the natives' ordinary dishes of rice or meal.
I have, &c.,
EMILIOUS HOPKINSON,
Protectorate Medical Officer.
The Senior Medical Officer, Bathurst.
GOLD COAST.
Cases more common on the littoral than inland, but supposed to extend inland along the Volta River, which is used greatly as a trade route.
The natives adopt a form of segregation, sending cases to separate huts, some times some distance away in the bush. No asylum for lepers exists. Such an in- stitution would not be of use for anything than a fraction of the cases in existence; there would be great difficulty in effecting the transport of the cases, and probably the effect of establishing such an institution with compulsory segregation would be to lead to concealment of the disease.
The natives are quite alive to the necessity for segregation, and, as far as I can judge, adopt it in nearly every case when the disease is once recognised.
(Extract.)
NORTHERN NIGERIA.
THE GOVERNOR to the SECRETARY OF STATE.
Government House, Zungeru, 22nd April, 1909. The Principal Medical Officer, Dr. Thompstone, C.M.G., has replied as fully as possible to the list of questions enclosed therein, which I now have the honour to transmit. Dr. Thompstone also states: "It is impossible to say how many lepers there are in the Protectorate. Many cases are seen sitting begging on the outskirts of the large towns in the interior. They are under no systematic supervision, but where numerous are often known to form voluntary communities; they are not habitually sent out of the towns.”
BASUTOLAND.
All the cases are inland. They are widely scattered through the Territory; about 40 per cent. occur as isolated cases in different villages. One village contains 12 lepers, one 8, two 7, one 6, three 5, thirteen 4, fifteen 3, twenty-nine 2. In fully 60 per cent. of the recorded cases is there undoubted evidence of contact with other lepers.
E. C. LONG,
Principal Medical Officer.
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AN ENQUIRY INTO THE LOCAL PREVALENCE OF LEPROSY IN NORTH Basutoland. By N. M. MACFARLANE, M.D., Leribe, Basutoland.
(A paper read before the South African Medical Congress.)
Mr. Jonathan Hutchinson, in his book on leprosy and fish-eating, remarks :— "My general conclusion is that leprosy in South Africa will always be found in ratio with the salt fish eating habits of the population, and that the latter depend upon facilities for supply, ancestral habits, and the existence of a large native population in a condition of dependence for maintenance upon the whites. To this it must be added that it is reinforced in certain native districts by a few cases caused by commensal communication-that is, by food taken from lepers' hands. It seems, however, very doubtful whether the latter is a sufficiently powerful source to maintain the disease for more than one or two generations in the absence of the food cause.'
"
Now, I hope in the following short paper to show that leprosy has nothing to do with salt fish eating habits of the Basuto, that there are little or no facilities for the supply of that commodity, that their ancestral habits are against fish eating, and that we have a large native population practically independent of the whites.
It will be shown, however, that the disease spreads from one person to another, and from one place to another by contagion or by what he chooses to call commensal communication, and that the causes have been sufficiently powerful to maintain the disease for more than two generations, and to aid its spread to an alarming extent so much so, that the native has been shaken out of his lethargy, and Chief Jonathan, in Leribe District, has been forced by his people to make pro- vision for an agricultural colony to which all his lepers can be sent.
During last month I have personally interviewed all the lepers in the northern district of Basutoland, and have been able to get some interesting histories and many important facts. Although I began my inquiries with an open mind in regard to the fish hypothesis, I must say now that tion between the two, and all the evidence in my possession points to its spread cannot find the least connec- by contagion, i.e., touch, clothing, breath, or food. This is also the belief amongst the natives, and they point to many cases in corroboration of it, and the present movement for a colony the practical application of this belief.
The Basuto, like the other Bantu peoples, have no name for leprosy, which would point to the disease being of recent origin among them. Engcobo, thinks it is indigenous, and that a fresh wave of the disease was started Dr. Weir, of by contact with Hottentots. There is something to be said for this, as we know that up to a hundred years ago the natives were not settled as we know them to-day, but were more or less nomadic and constantly at war one tribe with another, so that the unfit and the diseased had to go to the wall, and, in this way, a scourge like leprosy had no chance of gaining any foothold in a tribe or nation. But still, there is the objection that they have no native name for it, and to me this is a strong proof that it is of recent origin among them, as, had it been endemic, a disease with such marked characteristics as leprosy would have been distin- guished by a name. It is only when the tribes settle down in one part of the country and get prosperous that we have evidence of the disease, and this is especially true of the Basuto. It is about seventy years since leprosy was intro- duced into Basutoland; and, as regards the northern part of it, all my informa- tion points to the disease having spread from one part. This part is Mequatling, Modderpoort and the Plaatberg behind Ladybrand.
The Bataung tribe of the Basuto were living there under Molitsane and Ramochele, and scattered among them were the people they called Baroa, com- prising Bastards, Bushmen, and Hottentots, who had come there some time pre- viously from Phillipolis, and were people under the Bastard Chief Corolos, whom Moshesh had made vassal. These Baroa," as they called them, had leprosy, and from contact with them, and intermarriage, the disease attacked certain Basuto, who through war and other causes were driven into Basutoland proper. It is from these immigrants that the disease has sprung.