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does often (I am credibly informed) send some delicacy or other to his attendant's family who live in the immediate neighbourhood, and, by way of return courtesy, a sympathetic attendant's family return the compliment.
4. We all know the usual exchanging of civilities among the Singhalese and Tamils of this country, by the exchanging of betel, arecanut, &c,, between one another for chewing purposes. This is a matter of frequent experience in this asylum between patient and attendant, and I have seen patients covered with sores up to the tips of their fingers doing this act of civility to his attendant.
5. The attendants have, daily, carried the patients' soiled linen or have fre- quently carried the bed-ridden patients, or dressed twice daily or oftener the patients' sores with their bare fingers, as it is part of their daily duty to do so, and I have often seen them doing so having open wounds or sores on their bodies, even though often warned not to do so.
These attendants go to their homes, which are in the vicinity of the asylum, immediately after dressing the sores of the lepers and in their work-a-day clothes caress their children and often feed them with their hands. They are never over- particular of cleaning their nails.
With much persuasion and firmness we are endeavouring to put down these irregularities, but what has lasted for forty or fifty years or more cannot be sup- pressed in a few months. I mention this to show that in spite of this, leprosy has by no means spread in the village of Hendala and those others in its vicinity nor among the latrine coolies. Then again, the attendants of this asylum and their fathers before them for several generations have closely attended the patients. I have seen them applying pressure above asinus and wiping off purulent discharges with their fingers, and they have been doing this for years, and yet not one of them has contracted leprosy.
I repeat, with all these conditions existing since the establishment of this asylum-exactly 200 years now-that there has not been known to occur a single case of leprosy among the attendants or coolies or their families or the villagers around the asylum is a most significant fact.
Heredity.
With regard to the question of heredity, the registers of this asylum show that of the 1,700 under review, 180 patients confessed to the fact that their ancestors, paternal or maternal, suffered before from leprosy and died of that disease, and often it was within the knowledge of the Superintendent of the asylum that it was so, for they had been inmates of this asylum either together or at different times. Of these 180 patients in whom there was supposed to be hereditary taint,
133 were males and
47 females.
The number under each variety and their relative sexes were :-
Tubercular Anæsthetic Mixed
Males.
Females.
Total.
26
11
37
47
18
65
60
18
78
858
**
This chart (a chart was shown at the meeting) indicates particulars of three varieties of confessed hereditary lepers.
It is interesting to note the ages at which they had symptoms of leprosy dis- playing themselves.
In tubercular variety the period from 20 to 25 years of age seems to be the prominent time on which the symptoms of leprosy displayed themselves in heredity.
In anæsthetic between 5 and 10,
In mixed between 15 and 20.
Of course, these figures are taken from statements made by the patients themselves, and there is no reason to doubt their accuracy.
With such a large number as 180, whose fathers and grandfathers before them
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or with them had been treated for leprosy in this asylum, I fail to see how we can altogether discard the idea of heredity taking a part in the propagation of leprosy.
On the other hand, it is indeed difficult to distinguish the propagation of the disease by heredity from the propagation of the disease by commensal means.
It is a very common sight-in this country especially-to see a father or mother or their immediate ancestor feeding their child, and should such an ancestor be a leper how may we distinguish the propagation of the disease by commensal com- munication and the propagation of the disease by heredity?
To favour the idea of propagation by heredity there is a very unique case on record, in which the disease is said to have manifested itself in an infant three months after birth. His father was a leper in the asylum, and is responsible for the statement that this infant had symptoms of leprosy three months after birth. The following is an extract from the Register:-"No. 267, Kirimudianse 11 years of age admitted 21st Nov., 1882-Male-Singhalese-Anaesthetic Leper of Mahawela, Ratnapura District-His father is a Leper in the asylum--(Case No. 252)--Mother died in child birth-He is an only child-Vaccinated-His father states that some pale discoloured spots were observed on the boy's body on the back three months after birth, since which other fresh spots appeared and spread, forming patches on the back and buttocks. These spots and patches are stated to have lost sensation about a year ago. Small bulle appeared in the right heel and ankle and burst, resulting in ulcers which healed after a month. Two months since both his legs and feet got benumbed, followed soon afterwards by numbness of his forearms and hands."
Five out of the 180 of the supposed hereditary lepers had their first symptoms of leprosy manifested when they had passed their 55th year.
Death among Lepers during last 10 years.
Of those who died during the 10 years between 1897 and 1906, the particulars are as follows. There was a total of 525 deaths during that period.
Of these 525 deaths,
There were Tubercular
Anæsthetic Mixed
93
169 and 263
The largest number of tubercular patients seems to have died at the ages of 10 or under and the anaesthetic and mixed at the ages of from 10 to 20, so that the disease seems to be more active when acquired in early life than in later periods.
Age.
Then, as regards the ages in which the disease occurred, it is interesting to note that it is somewhat different in the tubercular as compared with the other varieties of the disease. In the tubercular variety, the largest number seems to have occurred between the ages of 20 to 25 years. In the anesthetic and mixed, between the ages of 25 and 30. But when it is considered that the tubercular variety is the least by far of the three varieties, it would not be well to place any importance on this slight difference. On the whole, the ages between 25 and 30 may be safely regarded as the probable period on which the disease manifests itself, at any rate in Ceylon.
Occupation.
It is interesting to note the various occupations of the 1,700 patients under review.
Of course, there is a large number-323-under the head of "No occupa- tion" for the simple reason that children under age and women who did household duties could not have been entered as any with an occupation. Of those with an Occupation, it is interesting to note that the "Cultivator" takes the pre-eminence. No less than 374 of the 1,700 were of that occupation.
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