CO885-(20-21) — Page 100

سلسلسا

PUBLIC RECORD OFFICE

Reference :-

C.O. 885

20 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH—NOT TO

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But as I stated before, there is a natural tendency for the poor, and especially those afflicted with sores, to gravitate towards the metropolis, where the chances of earn- ing a livelihood by begging are greater than in any other part of the island, and although the registers from which I have taken these notes inform us that their last place of residence was Colombo, it is by no means sure that they were born and had lived their lives in that city. It is, in any case, not pleasant to reflect that a large number of lepers are attracted to Colombo, and worse still that the tubercular variety of this disease is proportionately large among the patients from Colombo as compared with those from other parts of the island. Of the 523 admitted from

Colombo there were :-

Tubercular Ancesthetic Mixed

-

143

157 and... 223

The Korles around Colombo, it is a significant fact, have contributed a large number of patients. The most prominent being

Salpiti Korle

followed closely by

Siyana Korle

Hewagam

Alutkuru

Raygam

Pasdum and Hapitigam.

Moratuwa and Ratmalana alone, in Salpitikorle, have contributed 68 lepers. I have prepared a table of the localities in the different provinces that have contri- buted the 1,700 cases under review and have shown the number that each locality has contributed, also the number under each variety.

It is certainly a striking fact that the localities about the sea-board are those from which the largest number of lepers have come; but it is by no means clear that this helps us to the conclusion that leprosy is produced by eating fish imperfectly cured; for a very large amount of tank-fish, caught in filthy stagnant water, is eaten in the North-Central and North-Western Provinces in the interior of Ceylon, and yet these provinces have contributed 1 and 11 respectively of the 1,700 under review.

Two years ago I was asked by the Government to report on the distress of the parangi-stricken villagers of Demala-Hat pattu and travelling through the villages of that Pattu, I noticed that the villagers ate with their rice or kurakkan a large amount of tank-fish. The tanks were at that time run dry by the drought, and most of the fish that remained were found dead in the mud at the bed of the tanks and the village boys were running away with them to their homes to cook and eat them. Acute diarrhoea occurred shortly after in two of these villages, but leprosy was hardly known among them.

Jaffna, where fish is consumed in abundance, contributes 12 of the 1,700 under review rather a poor percentage to prove that leprosy is caused by eating fish im- perfectly cured.

As regards sex, of these 1,700,

Sex.

1,431 were males

269 females

1,700

or 1 female to every 5'32 males.

The proportionately large number of males as compared with the females is, I believe, chiefly due to the greater amount of exposure the males have to the con- ditions (whatever they are) that favour the propagation of the disease. also be borne in mind that females in their homes have better chances of escaping It must detection of the existence of the disease in them and their eluding the vigilance of those interested to send them to the asylum.

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Variety.

As regards varieties of these 1,700-there were :-

Tubercular Anæsthetic Mixed

340

679

681

1,700

the tubercular thus being half that of the other varieties. small number of the tubercular as compared with the other varieties is significant. The proportionately If we are allowed to draw any inference from statistics taken from the asylum registers, I would be inclined to believe that the comparatively mild condition of the contagiousness of leprosy, as seen in Ceylon, is due in a great measure to the proportionately small number of the tubercular variety of the disease. It is an admitted fact that the quantity of "bacillus lepræ" is different in the different varieties of the disease. Scheube says that "the difference in the quantity of the bacilli in tubercular and nerve leprosy is remarkable and hitherto has remained unexplained. The tubercles and infiltrations of tubercular leprosy usually contain myriads of bacilli, while in nerve leprosy they are only found in small numbers in certain parts of the nerves or they may even be quite lacking. Perhaps in nerve leprosy the bacilli soon perish, and their toxin plays an important rôle in the development of the disorder." of patients in the registers of this asylum for the last 44 years has been treated for But, as I have just mentioned, the largest number the mixed variety of the disease, viz., no less than 681 cases out of the total of 1,700 under review. It must, however, be mentioned that the cases known as mixed are chiefly anesthetic, with slight symptoms of the tubercular variety appearing somewhere on the body, especially on the face and ears. personally, so far, I have seldom met with a tubercular case without some symptoms I may here mention that of anesthesia being present either preceding, succeeding, or co-existent with, tuber- cular symptoms. The anaesthetic and tubercular varieties may at the start be dis- tinct and uniqué, but frequently as time goes on the two varieties blend together. The nerves are affected in both, and nodular growths in the ear and nose occur in the course of nerve-leprosy, and often under Chaulnoogra treatment the nodules of the tubercular form disappear, leaving symptoms of the nerve form only. occurs particularly among the young leper-patients. That is, those whose ages are This less than 25.

Propagation of the Disease.

The question that naturally occurs under this head is, how far or how much are we to believe in the propagation of leprosy by contagion. Of course one cannot help but conclude that as long as there is a specific bacillus of leprosy, the pro- pagation of the disease from a leper to a healthy human being is by the bacillus somehow finding its way from one to the other, under the distinct condition, how- ever, that successful contagion and propagation can only take place when the recipient is ready to receive the bacillus and have it thrive in him. Or in other words, there is a particular condition (which condition is still shrouded in mystery) on the part of the recipient which can render contagion successful, followed by the propagation of the disease.

may, however, be permitted to state my own personal observations in the Hendala Leper Asylum. When I took charge of this institution I made a point of finding out, as best I could, all about the commensal mode of contagion of leprosy. I was not long in noting the following:

1. That the boundary wall of this asylum was infested with pauper children from the villages in its immediate vicinity, stealthily seeking and begging at each meal-time from outside for food from the patients. There is no doubt that remnants of the lepers' cooked food have been freely distributed to them, especially by the Buddhist patients. This had evidently been an established practice for a very long time.

2. I have also seen the latrine coolies of this asylum (Malabars) openly sitting among the lepers of their acquaintance and exchanging their curries or any other delicacies with them.

3. Then again there is the food taken by the attendants of this asylum and freely interchanged with the food of the patients, especially those with whom the attendants chum up.

A patient, to show his gratitude of affection to his attendant,