CHAPTER 17: LEPROSY INCURABLEHYGIENE THE ONLY PALLIATIVE.
LEPROSY has been regarded in every age and in every country as an incurable disease.
In the Encyclopedia Britannica, leprosy is described as an incurable constitutional disease, marked externally by discoloured patches and nodules on the skin, and deeply implicating the structure and function of the peripheral nervous system.
How improbable was all hope of cure of leprosy may be inferred from ancient customs in various countries, notably in France.
Dr. Macnamara in his work on "Leprosy," p. 36, cites authorities to show that the leper was expelled from society, and looked upon as dead.
He observes :" The leper was not looked upon in the eye of the law alone as defunct, for the Church also took the same view, and performed the solemn ceremonials of the burial of the dead over him on the day on which he was separated from his fellow-creatures and consigned to a lazar-house. He was from that moment regarded as a man dead amongst the living, and legally buried, though still breathing and alive. The ritual of the French Church retained till a late period the various forms and ceremonies to which the leper was subjected on the day of his living funeral. Ogee and Ploucquet have both described them.
"A priest robed with surplice and stole went with the cross to the house of the doomed leper. The minister of the church began the necessary ceremonies by exhorting him to suffer, with a patient and penitent spirit, the incurable plague with which God had stricken him. He then sprinkled the unfortunate leper with holy water, and afterwards conducted him to the church, the usual burial verses being sung during their march thither. In the church the ordinary habiliments of the leper were removed; he was clothed in a funeral pall; and while placed before the altar between two trestles, the Libera was sung, and the mass for the dead celebrated over him. After this service he was again sprinkled with holy water, and led from the church, to the house or hospital destined for his future abode. A pair of clappers, a barrel, a stick, cowl, and dress, etc., etc., were given to him. Before leaving the leper, the priest solemnly interdicted him from appearing in public without his lepers garb; from entering inns, churches, mills, and bake-houses; from touching children, or giving them aught he had touched; from washing his hands, or anything pertaining to him, in the common fountains and streams; from touching in the markets the goods he wished to buy with anything except his stick; from eating or drinking with others than lepers; and he especially forbade him from walking in narrow paths, or from answering those who spoke to him in the roads and streets unless in a whisper, that they might not be annoyed with his pestilent breath, and with the infectious odour which exhaled from his body; and last of all, before taking his departure and leaving the leper for ever to the seclusion of the lazar-house, the official of the church terminated the ceremony of his separation from his living fellow-creatures, by throwing upon the body of the poor outcast a shovelful of earth, in imitation of the closure of the grave."
Referring to more recent events, I find that in the report of the Special Sanitary Committee on the state of the Leper Settlement at Kalawao, Hawaii, 1878, addressed to the Hon. G. Rhodes, President of the Legislative Assembly, so little expectation of cure was there, "that lepers have to pay for their own coffins, and have formed a coffin association in order to provide a common fund for their proper interment, and these sad creatures get up, as shown by the register of the Hospital, Coffin Feasts, on which occasion money is contributed to provide for a decent termination of their woes."
Alluding to the disappearance of leprosy in England, Gilbert White observes in a letter to Mr. Barrington
"This happy change perhaps may have originated and been continued from the much smaller quantity of salt meat and fish now eaten in these kingdoms; from the use of linen next the skin; from the plenty of better bread; and from the profusion of fruits, roots, legumes, and greens, so common in every family." It may also be added that, at the time when leprosy disappeared from this country, the practice of inoculation and vaccination was unknown, otherwise there is little doubt that leprosy would have been perpetuated in England by the empoisoned lancet, as it is now in the West Indies, British Guiana, India, New Caledonia, the United States of Colombia, Venezuela, and Hawaii.
Commenting upon the Royal College of Physicians Report, Drs. Tilbury Fox and Farquhar observe that:
"The cause of leprosy is as obscure as ever, and upon this particular matter the leprosy report gives us very little satisfactory explanation, beyond illustrations of the general statement that leprosy disappears pan passu with an improvement in the hygienic condition and diet of a people, and the cultivation of land in districts where it has abounded."India Office Report, London, 1872, p. 28.
Sir Erasmus Wilson, in his article on "Leprosy" in Quains "Dictionary of Medicine," refers to the various drugs which are recommended and used by one physician or anotherquinine, strychnine, phosphates, nitric acid, acetic and carbolic acid, iodine, arsenic, perchloride of mercury, asclepias gigantea, hydrocotyle asiatica, veronica quinquefolia, plumbago rosea, acid nitrate of mercury, potassa fusa, acrid irritating oil of the shell of the cashew nut, chloride of zinc, etc. In no case is it mentioned that a cure is effected, or even to be expected, but rather the other way. "Hope," he says, "will gleam in the mind of the physician and patient; but cure, alas! is as distant as ever."
Dr. P. Abraham, the Secretary of the Leprosy Investigation Committee, who is familiar with all medical literature on the subject, gave his opinion at a discussion "On the Cure of Leprosy" before the Royal Medical and Chirurgical Society, May 27, 1890, that "the disease was probably not curable; though it might abort and die out."(British Medical Journal May 31st, 1890.) And on another occasion he observed that therapeutic agents had proved failures and that there was no specific for the disease.
In a report of the Paris Congress of Dermatology, 1889, printed in the Journal d Hygiène, October 23rd, 1890, the subject of leprosy was discussed.
M. Cornil observed: "We must not confound a passing amelioration, a diminution or attenuation of the malady, more or less prolonged, with cure properly so called."
Consul-General Abbott, in a letter dated June 8th, 1891, Rio de Janeiro, says: "I do not think any radical cure for leprosy has yet been discovered."Journal of the Leprosy Investigation Committee, No. 4,. December 1891i, p. 18.
The health authorities in Hawaii, as well as the most experienced medical residents elsewhere, consider leprosy as practically incurable, though they acknowledge that life may be prolonged by good food, pure water, healthy habitations, and other favourable sanitary conditions. On one occasion, referring to the reports of certain medical practitioners as to their alleged and officially reported cures, I was told by one of the responsible officials that the cures were mythical, the particular cases cited having since exhibited further development of the disease.,
It is alleged that the external manifestations of leprosy, like those of some other maladies, disappear for a time, either with or without treatment, and cures are noised abroad; but the disease invariably reappears, and shows itself when least expected.
In the year 1866, the disease had begun to assume alarming proportions in the Sandwich Islands, and the people strongly suspected that the increase was partly, if not largely, due to vaccination. I am unable, however, to find any medical admission of the fact, until some years later. A law was passed in 1868, declaring the disease to be contagious, and requiring all lepers to be removed to the Island of Molokai, where the Government had set aside a piece of land on the northern side for a leper settlement. The preparations for the reception of these unfortunate people were, at first, of the rudest description. The patients were lodged in the cottages of the few Kamaainas, or freeholders on the estate, and were without any appropriate nursing or attendance; and, according to the evidence of Mr. Ambrose Hutchinson, who in 1884 was Under-Superintendent, as the disease was considered incurable, it was the custom to send along with each patient, by the same conveyance, the coffin he was soon to occupy.
The report of the Honolulu Board of Health to the Minister of the Interior for 1876 states (page 77) that the Legislature of 1874 made an appropriation of six thousand dollars towards the expenses (for curing leprosy) of Drs. Powell and Akana, who were offered every facility to try their skill. Six patients were experimented upon with various drugs. Dr. Akana claimed to have cured one, who was subsequently examined by a number of physicians and sent to Kalawao as a confirmed leper. The Board reported that all attempts to cure any patient afflicted with leprosy had failed.
In an address delivered by Mr.. Dole on the subject of "Leprosy in the Hawaiian Islands," which the Boston Medical and Surgical Journal of May 15, 1884, commends to the attention of the National Board of Health, United States, is the following description of this malady : "Leprosy is the worst known disease of the present and historic times. It has successfully defied medical skill. Physicians have not been able to say whence it comes, or to explain its laws. It has always and every where been found to be incurable. It attacks all races and all classes; no rank in life is safeadults and children are alike exposed to its ravages. Medical skill can , make no limit; no assurance can be given from the lessons of experience against this most terrible, most loathsome, and most hopeless of all human diseases."
Dr. A. W. Saxe, in a card published in the Hawaiian Gazette of May 23, 1883, says that for leprosy there is no known cure.
In a paper on "Leprosy in Hawaii," published in the Occidental Medical Times, April, 1889, Dr. F. B. Sutliff, the writer, sums up the results of his experience in the Island of Maui, Hawaii. "Treatment," he observes, of any kind had, so far, proved useless. Improvement which has been noted in many cases is only temporary;" and again, p. 208, "The disease is hopelessly incurable, and certainly fatal."
In the biennial period ending 1881, the report of the Board of Health states that an appropriation of $20,000 was made by the Legislature of Honolulu for the cure of lepers, or $200 each; but no cures were effected, though numberless experiments on these unfortunates were tried, causing much suffering, and in one case the suicide of the victim experimented upon.
In his report to the Board of Health, dated November 14, 1885, and addressed to His Excellency W. M. Gibson, Dr. Edward Arning observes :" There is scarcely a drug in the pharmacopoeia, at least scarcely a class of drugs, that has not been most systematically tried in the treatment of leprosy. Over and over again men of sanguine temperament have found what they called, a specific cure, but in every instance calm and unbiased judgment has afterwards pronounced a verdict of uselessness."
This distinguished authority also observes :" I am fully satisfied that Dr. Unna has as yet not succeeded in perfecting a cure of leprosy in a single case. He himself has told me that one of the published cases of complete cure has since suffered a relapse."Biennial Report, Board of Health, Honolulu, 1892, p. 5.
Leprosy is not confined, as many suppose, to native Hawaiians. Dr. E. Arning says :" Among the white population, numbering 17,935, I knew of thirty-five leprosy cases."
Dr. N. B. Emerson, a lepra specialist of Hawaii, says:" In spite of a number of claims to the contrary, we believe it safe to say. that no one has been able to prove, to the satisfaction of the medical profession, that a single case of this disease has been definitely cured."
In a volume entitled "Leprosy in Hawaii," published by the Hawaiian Government at Honolulu, 1886, p. 73, it is said :" Experiments are carried on constantly on patients at Kalihi, and on very incipient, or rather doubtful cases, at their own homes. Though some patients have certainly improved a .great deal under careful treatment, we cannot, for the present, state one case of cure."
Dr. Prince A. Morrow, of New York, in "Personal Observations of Leprosy in Mexico and the Sandwich Islands," says, p.5:" We know that leprosy has a prolonged, but somewhat indefinite, period of incubation, a slow and irregular course of development, a characteristic and well-defined symptomatology rendering its diagnosis easy, and that its prognostic significance is most grave. It progresses almost invariably to a fatal termination."
Dr. Hoffman, of Honolulu, alluding to the Leper Hospital at Kalihi, of which he had charge for some years, reports that generally fifty cases were under treatment from time to time, these being equally divided between the tubercular and the anaesthetic. He says :"I found no permanent benefit from treatment; better food and cleanliness, medicine suited to improve the general health of the leper, ameliorated the disease temporarily."Report on Leprosy, Honolulu, 1886 p 75.
Dr. Arthur Mounitz, Resident Physician and Medical Superintendent of the Leper Settlement, Molokai, in his Report, dated Molokai, February, 1886, says of the Kalawao Hospital, where the worst cases are supposed to be accommodated :"Of course, there are no cases of cure, and those who enter its portals remain until death releases them ;" and under the head of "Treatment," says:
"This is the briefest question of any to deal, with, but the most disheartening to a physician; for, so far, no remedy has been found beneficial." Dr. E. Cook Webb physician to a branch hospital at Kakaoko, in his report, dated March 1st, 1886, says:" As regards the treatment of leprosy, I have but little to say. Notwithstanding any treatment which I have used, or seen used,. I cannot see any change in any single case. I am fully convinced, after considerable study and experience, that personal cleanliness, good nourishing food, and regular habits have done more towards the relief of these unfortunates than all the medicines that have ever been prescribed for them in the past. In all the cases of leprosy. I have seen, the disease has steadily progressed to a fatal termination, notwithstanding all treatment. I am aware that I am taking strong ground against the many so-called cures that have been devised, but in so doing I am not basing my opinion on my own study and experience alone, but on the medical opinions of those who for years have been in daily contact with the disease, and have made it a special study, and they have come to the conclusion that it is a disease sui genenis, and incurable."
In the report of the President of the Board of Health, addressed to the Legislative Assembly, Honolulu, 1886, p. 49, in reply to the question, "Is Leprosy Curable?" Mr. F. W. Hutchinson says :" To this question we are constrained to answer No! At least not under any known treatment."
Dr. Sidney Bourne Swift, late Resident Physician of the Leper Settlement, Kalawao, Molokai, Hawaii, in his report to the President of the Board of Health, refers to the failure of medical treatment and the numerous alleged cures reported by experimental bacteriologists. "What has become of the cases cured by Fitch, by Arning, by Goto, and by Lutz? Come to the Settlement and you will see them in their graves."Biennial Report of the President of the Board of Health to the Legislature of the Hawaiian Kingdom, Honolulu, 1892, p. 87.
THE WEST INDIES AND BRITISH GUIANA.
Dr. Gavin Milroy, in the "Report on Leprosy and Yaws in the West Indies," published in 1873, p. 43, observes:" We have already seen that in the Barbados Asylum several of the patients had been benefited when no medicinal remedies whatever had been used, the good results being attributed solely to the more regular mode of life, better supply of food, and better housing since their admission, and to their withdrawal from all occasions of intemperance on the one hand, and of destitution on the other. Like effects have been observed in the asylums of other Colonies."
On pages 99 and 100, Dr. Milroy says :" There is a unanimous accord of opinion that the greatest benefit is derived from the adoption of hygienic measures, and that by improving the general conditions, physical and moral, of the leprous poor, very much may be done to retard or arrest the malady in its early stages, and also to mitigate its severity when more fully developed. Medicinal treatment is universally admitted to be, of no avail, unless combined with the regular use of a nutritive, unstimulating diet, suitable clothing, protection against the vicissitudes of weather, personal cleanliness, and exercise in the open air. There. is certainly no medicinal substance, vegetable or mineral, which exerts anything like a direct or specific effect on the malady
"The evidence is all but unanimous that leprosy very rarely, if ever, manifests any tendency to a spontaneous cure. When fully developed, a complete recovery is not to be looked for. It is quite apparent, however, that the progress of the disease may often experience a marked retardation of arrest when the patient is maintained in a favourable hygienic condition."
Dr. J. F. Donovan, Superintendent, Leper Home, Jamaica, in his annual report for 1891, says :" For curative purposes, I think most authorities will acknowledge that we must look for some other method besides. the administration of medicinal remedies, as drugs have been tried extensively and persistently, and have so far signally failed of effecting a cure of this formidable pest." Supplement to Jamaica Gazette, 18th June, 1891.
In the same report, Dr. Donovan makes the following statement as to the condition of patient No. 5, afflicted with tubercular leprosy :" After medical treatment, the scaly eruption about the flexor aspect of joints has. disappeared, the plagues of tubercle on face, forehead, etc., and the enlarged inguinal glands are in statu quo after a months steady use of the inunction and mixture. Symptoms of pulmonary phthisis set in when the gurjun oil was discontinued, as it caused nausea, and subsequently diarrhoea ensued, which the patient attributed to the medicine. A variety of drugs were used to combat the hyper-pyrexia, but without effect." Supplement to the Jamaica Gazette, June 18th, I89I, page 81.
Under the head of "Cure," Dr. J. F. Donovan observes in the same report :" In some cases the tubercles decrease for a time; in a few years, it may however be mentioned, that the tubercles have been known to subside spontaneously in some patients for a time, who. have been taking no medicines; so too the tubercles may enlarge and increase in numbers during the administration of the drug, as was evidenced in three of our most prominent cases at the Home."
"There are few diseases which are less amenable to treatment than leprosy; the entire armoury of known drugs has been tried," says this medical superintendent, and found ineffective."
I may here observe that Dr. Kochs much vaunted tuberculin has been tried in almost every leprous country on the globe, and found worse than useless. Much suffering has been caused by its use. The Madras Times, October 28, 1891, reports the visit of His Excellency Lord Wenlock to the leper hospital in this city, when his lordship had pointed out to him several patients upon whom Dr. Kochs lymph treatment had been tried. One of the patients complained that the experiment had subjected him to excruciating pain.
Dr. W. V. M. Koch, Acting Medical Superintendent, Leper Asylum, Trinidad, says :" During the past year there has been scarcely any advance made in the treatment of this disease (leprosy) and it continues to baffle the most skilful physician. Various new remedies have been tried, but without success."
"No drug has yet been used which exerts a specific action on leprosy."Appendix to Report on Leprosy and the Trinidad Leper Asylum, 1891, pp. 72, 73.
In the appendix to Dr. Beaven Rakes report on Leprosy and the Trinidad Leper Asylum," dated Maraval, February 4th, 1890, it is admitted that the inoculation of animals has proved a failure, and human beings are required as clinical material for experimental purposes. Dr. Rake, p. 36, says :" If the Home Government could see its way to sanction the inoculation with leprosy of two or three condemned criminals in Trinidad, and the commutation of their capital sentences to imprisonment for life, important additions could be made to our present knowledge of the pathology and proper treatment (by segregation or otherwise) of the disease. I can safely predict that many criminals would gladly accede to such an alternative, on having the case clearly stated to them."
Dr. Beaven Rake, himself a great experimenter, says: "Campana inoculated lepers with erysipelas, with the result that nearly all the patients in the ward got erysipelas, and the ward had to be closed. No effect was produced on the progress of the leprosy."Report on Leprosy in Trinidad for 1890, p. 37.
Dr. John D. Hillis, of Demerara, observes in his work, Leprosy in Biitish Guiana," p. 209 :" The treatment of leprosy has hitherto been attended with such very poor results that the disease is now regarded as incurable. Drug after drugso-called specificshave been tried, only to be laid aside as useless, the disease after a time returning with greater violence than ever." The writer then proceeds to describe some of the experiments to which the unfortunate lepers have been subjected. Out of seventy cases treated by Dr. Danielssen at the Lungeguards Hospital, Bergen, only one was reported cured.
It appeared to me, however," says Dr. Danielssen (page 210), "if I could infect the leprous patients with constitutional syphilis, it might follow that the syphilitic poison might prove superior to that of leprosy, and that thus the system might be brought to that of a person labouring under constitutional syphilis, and might so become subject to the ordinary process of syphilisation." "This ingenious theory, however," remarks Dr. Hillis, "failed in practice, the leprosy remaining unchanged, whilst the syphilitic process went on."
Under the head of " Palliative Treatment," p. 215, Dr. Hillis says:" Improving the sanitary condition of the leper, it is well known, has great influence in mitigating the disease; and the satisfactory results which have been realised in this direction at the General Leper Asylum may. be seen in the following figures, taken from my official report for 1878, when the percentage of deaths to strength for the past four years was stated to ,be :
1875. 1876. 1877. 1878.
17.36 per cent. 16.33 per cent. 11.49 per cent. 9.19 per cent.
In the appendix to the report of the Medical Officer of the Leper Asylum, Mahaica, British guiana, for 88o, printed by order of the Court of Policy, Dr. Oscar D. Honiball, Acting Medical Officer to the Leper Asylum, after alluding to the prominent physiological action of gurjun oil, which are purging and vomiting, considers it would be a fatal mistake to administer it in advanced cases. Dr. Honiball records with considerable regret and disappointment his failure to discern its alleged beneficial results. He has also made careful inquiries of the inmates, and the answer as to the beneficial results have been either of a negative nature or strongly adverse. Some say, I am not worse than when I came in." On the other hand, very many bitterly complain of the deleterious qualities, attributing to its administration a rapid and violent increase of the disease. It is so nauseous, and the results following so very often serious, and at all times disagreeable and inconvenient, that the assumption of its curative properties should be based upon a surer basis than hypothesis."
Dr. Castor, Medical Director, Leper Hospital, Demerara (who acknowledges that vaccination is a certain mode of spreading leprosy) says that no therapeutic agent is of any avail as a cure.
Referring to Dr. Castors report to the Surgeon-General, British Guiana, for 1888, the Lancet, March 8, 1890, p. 566, observes :"Although every remedy reported successful elsewhere has been tried, no beneficial result has been obtained. Dr. Castor holds the opinion that the most that can be done in the way either of cure or prevention is by proper diet, dwellings, and sanitary surroundings to ameliorate the symptoms, and often thereby control them."
AMERICA AND CANADA.
In a chemical lecture on "Anaesthetic Leprosy," by Professor James Nevins Hyde, in the American Practitioner, February, 1879, the author says :" Needless to say that mercury, iodine, quinia, arsenic, and a long list of other remedies, have utterly failed to eradicate the disease. A careful study of the results said to have been obtained by the use of gurjun oil, employed in the Beauperthuy method by Dougal, and of the cashew-nut by De Valence, will lead ,to the conviction that the benefit was largely due to the improved hygienic condition of the patients submitted to experiment. Where we are ignorant it is best to admit the fact; for we thus show that we have at least learned the alphabet of wisdom."
Dr. J. E. Graham, of Toronto, in reply to a communication from the Hawaiian Government regarding leprosy in New Brunswick says, that he has experienced ." no good results from medical treatment. Much may be done by attending to the general health of the patients." Leprosy in Foreign Countries, Honolulu, 1886, p. 158.
Dr. H. S. Orme, President of the State Board of Health, California, in his valuable papers on "Leprosy, its extent and control," says :"The general testimony is to the effect that any mode of treatment is disappointing. Arrest of progress is only temporary, being usually followed by suspension of treatment. Indeed it is not certain that long perseverance would be attended by permanent relief. At the Tracadie Hospital, patients have been discharged apparently cured, but they generally returned to die. The results are even less encouraging than the treatment of pulmonary consumption. The Health Authorities of the Hawaiian Islands consider leprosy practically incurable, though they acknowledge that life may be prolonged by certain medical treatment, by good food, and by favourable sanitary conditions."
Dr. James H. Dunn, Professor of Dermatology, Mineapolis, in a chemical lecture reported in the North- Western Lancet, March 1, 1888, says :" The treatment of leprosy is accordingly largely palliative. Of course, cures popular, medical, and secrethave not been wanting; but their unreliability has been repeatedly demonstrated. Of prime importance, if possible, is the removal of the patient to a country or part of the country in which the disease is not endemic, preferably a healthy mountainous district with good air, nourishing food, and every hygienic appointment, and the use of baths and electricity in proper cases."
In reply to a communication addressed by me to the Superintendent of the Lazaretto, Tracadie, New Brunswick, Mr. J. A. Babineau, November 12, 1889, writes : "Leprosy is considered incurable here, as elsewhere, for all attempts to cure the disease have failed."
Dr. J. C. Tache, Visiting Physician to the Tracadie Lazaretto, in p. 150, "Leprosy in Foreign Countries," says :" The various and multiplied attempts made at different times in New Brunswick by medical men, or under medical guidance, to cure the disease have all failed."
Dr. A. C. Smith, writing from New Brunswick to the Hawaiian Government, says :" I have never observed more than a temporary amelioration from any medical treatment, and only such as might be attributed to the effect of mind over body. My predecessor used coloured water, accompanied by strong assurances of benefit therefrom, and in every instance found a temporary improvement equal in degree to any apparent benefit to be found from the use of medicinal agents." "Leprosy in Foreign Countries," p. 156.
United States Consul James W. Siler, of Cape Town, South Africa, in the report to his Government, after referring to various so-called remedies,, observes :" After all, these and other remedies only tend to prolong the disease; for, once affected with the leprous taint, the victim is doomed to slowly but surely rot away, until mercifully released by death." United States Consular Report for 1887, p. 565.
Owing to the remarkable spread of leprosy in Venezuela, the United States Consul, Mr. E. H. Plumacher, has paid much attention to the treatment of that disease; and he reports to his Government (No. 119, for 1890, pp. 695-6) as follows :"Various methods of treatment have been tested at the Maracaibo Lazaretto, especially the administration of the oil of chaulmoogra, which apparently gives encouraging results at first, but produces no lasting benefit. Its use is also attended with grave physical inconvenience, such as a morbid state of the liver; intestinal irritations, accompanied with a slimy and waxy diarrhoea; wandering pains in various parts of the body; eruptions upon the skin, principally attacking the hands, and various other unpleasant attendant symptoms, making the use of chaulmoogra at times intolerable." . . . This treatment has always been entirely voluntary, but no one has been able to persevere in its use. The iodides and mercurial preparations have also been tested, as well as the tincture of cantharides; but all of these remedies produced more or less identical effects that of a temporary amelioration of the condition of the patient, but without well-founded hopes of anything approaching a genuine cure. . . . As already stated, temporary alleviation has frequently been obtained by various methods, as, in a disease like leprosy, any remedy which tends to improve the state of the blood and the general health will, no doubt, have its temporary ameliorating effect upon the malady itself. So many years of careful study, and of patient and conscientious application of all methods of treatment, have, in my opinion, satisfactorily demonstrated the incurability of the disease; and the most that can be done is to alleviate, as far as possible, the physical suffering and mental distress."
Miguel Valladores, Physician of the Lazaretto, Guatemala, says :" I have observed that mercurial treatment aggravates the disease of leprosy in a patient."Leprosy in Foreign Countries: Honolulu, 1886, p. I74.
INDIA AND OTHER COUNTRIES.
In a report to His Hawaiian Majesty, dated August 12, 1885, by Surgeon-General W. J. Moore, of Bombay, the author says:" If leprosy is not what I hold it to be, we have still sufficient evidence that the great prophylaxis is sanitation. In sanitation I include the prevention as much as possible of whatever entails a state of human system below par, such as the cheapening of salt (an article of the greatest importance in the human economy), plentiful food, good clothing, suitable and, above all, dry lodging, drainage, conservancyin short, everything tending to improve the condition of the population of a country. Leper asylums are good and charitable, but will not cure, eradicate, or prevent leprosy. There is no known cure for leprosy when once contracted. Lepers taken into an asylum and well cared for often apparently recover; but the apparent recovery is this: The cachectic debilitated leper becomes temporarily a robust leper, but he remains a leper still, and the disease eventually breaks out again. Apart from charitable motives, therefore, I would not recommend the Government spending large sums on leper asylumssuch, for instance, as would be entailed by a State Leper Asylum, as mentioned in Government Resolution No. 2009, dated 11th June, 1883. A more certain, albeit slow, progress will result from sanitation in the broadest sense of the term, which comprises the moral and amelioration of the condition of the people" And in a letter to the British Medical Journal, December 14, 1889, p. 1371, Sir William J. Moore observes :" I feel most confidence in the diminution of leprosy in India, and in the prevention of leprosy in this country, from the influence and progress of sanitation in the most extended sense of the term, in which I include the cleansing generally of villages and towns, drainage, ventilation, good water supply, the cheapening of salt, the prevention of scarcity, opposition to imprudent marriages, and measures for the prevention of specific disease."
Mr. W. Walker, Inspector-General of Civil Hospitals, North-West Province of Oudh, in his report of June 26, 1885, to the Government, observes :" I may say that medical treatment, in the sense of attempting a cure of the disease, has been abandoned, not only in these provinces, but all over India. Extensive experiments were made in 1875, 1876, and 1887, with regard to the efficacy of certain systems of treatment, and were found to be equally unsatisfactory. If the Government will refer to proceedings in the Medical Department, Nos. 20 and 23, dated March 10, 1887, there will be found the result of a fair trial given to gurjun oil, once a vaunted cure for leprosy. The results of this experiment may be taken as a fair example of the conclusions which have been forced on all trustworthy observersnamely, that good nourishing diet, cleanliness, and friction of the skin with any oil, are the only satisfactory means of retarding the progress of the disease. No other specific treatment is now attempted in any of our asylums. The patients are regarded as incurable, and are only subjected to medical treatment when attacked by complications which may be hopefully dealt with."
J. Fairweather, Brigade-Surgeon, Inspector-General of Civil Hospitals, Punjaub, says :" All attempts at specific treatment have been abandoned for some years as useless."
Dr. W. R. Kynsey, Chief of the Medical Department, Colombo, Ceylon, in reply to a communication from His Hawaiian Majestys authorities as to leprosy in India, writes :" No treatment has yet been found of any permanent benefit. The best results have been obtained from hygienic and dietetic treatment alone." "Lepers," he says, "are chiefly found among the poorer natives, whose dwellings are small thatched huts, crowded, ill-ventilated, filthy, and strewn with mouldy and rotten vegetables and excremental deposits. Leprosy in Foreign Countries, Honolulu, 1886, p. 164.
Mr. H. A. Acworth, Municipal Commissioner, Bombay, says :" Who ever heard of a case of cure?"
Dr. R. J. Wright, Civil Surgeon, Jessore, India, says:" Six hundred and nineteen lepers are reported in the Jessore district. The sex is not distinguished; but it appears that only fifty-four inherited leprosy, while six hundred and sixty-five have no idea of its cause. They believe the disease incurable, so it is difficult to persuade them to submit to treatment, and twenty who were treated with gurjun oil derived no benefit."Leprosy in Foreign Countries, Honolulu, 1886, p. 34.
Dr. H. V. Carter, of Bombay, in a communication to the Hawaiian Government, relative to leprosy in India and Norway, dated 1884, says:"In limine, I should state that the cure of leprosy by purely medical treatment has not practically contributed anything towards the obliterating of the disease. To rely, therefore, for a general amendment, upon any of the varied remedial measures often confidently put forward, would be to indulge in fallacies, hurtful as well as deceptive, and to encourage a kind of anticipation hitherto shown by experience to be futile."
Again, the same writer, in part II. of the same paper, observes :" Nor has purely medical treatment ever proved curative; and, so far from leprosy in Norway showing a natural tendency to subside, there is ample evidence of a present activity, equal to that displayed by the disease twenty - five years ago." Leprosy in Foreign Countries, p. 96, Honolulu, 1886.
In a summary of his work for 1890, in the Leper Asylum at Dehra Dun, India, Dr. MLaren, the Medical Superintendent, gives the result of the treatment with resorcin icthyol and gurjun oil, which were used a short time ago, but are now, apparently, abandoned. He says :" There is not the least appearance of permanent benefit, or of any amelioration of the actual disease." Calcutta Englishman, March 7, 1891.
In his "Remarks on Leprosy," the same authority observes:"It may not be out of place here to mention that, since 1875, I have given the most careful attention to the treatment of leprosy; tried most conscientiously all the various drugs that have from time to time been recommended, and used unsparingly, and for prolonged periods, all outward applications that have been brought to notice, and must frankly admit that I have not witnessed the least permanent benefit from any one of these. . . . Once a leper, always a leper, is the sad outcome of my many years close observation, let the treatment be what it may."My Leper Friends, by Mrs. Hayes, London, 1891. pp. 125-6.
Under the head of "Treatment," the chief medical officer of Kashmir, Dr. A. Mitra, after alluding to the use of arsenic, chaulmoogra oil, and gurjun oil, observes that they have little or no power in arresting the progress .of the disease. And as regards nerve-stretching, which, in the early stages of the anaesthetic variety, produces very satisfactory results in a large majority of cases, he remarks "the result is not lasting."The American Journal of Medical Sciences, July, 1891.
The Bombay Gazette, 17th July, 1891, reports the opening of the New Leper Asylum at Sehore, Bhopal, towards which Her Highness the Begum of Bhopal has contributed munificently, and has promised an annual grant of 4500 Rs. for the expenses of maintenance. The building will accommodate about 160 lepers. In his address, Surgeon-Major Dane frankly said, "We do not expect to cure these unfortunate people, as, notwithstanding the praises which are repeatedly being bestowed on some vaunted certain cures there is no doubt that a cure for leprosy has still to be discovered." This benevolent lady, the Begum of Bhopal, Nawab Shahjeham, has been persuaded to extend vaccinations in her province, upon which she spends 5000 rupees yearly, employing 35 vaccinators, who performed 38,000 vaccinations last year, thus unwittingly spreading the fell disease at the point of the lancet, and helping to fill the wards of the hospital which her benevolence has established.
Babu Prosurmo Coomar Sein, Gurbetta, India, in reply to questions from the Hawaiian Government, reports as follows : " After taking charge of this dispensary, I have treated twenty lepers. To some of them this disease was hereditary, to some it was owing to the contagion, and to others it was the effect of using mercurial medicines."
Surgeon W. D. Stewart, Civil Surgeon of Cuttack,. says :" There is a belief that excessive use of mercury tends to develop the disease, by causing a deteriorated state of the blood and tissues."
Babu Jaggo Mohoun Roy, Orissa, reports :" In the generality of the cases, especially among the Hindus,. venereal diseases, and perhaps administrations of mercury for their cure, have, I believe, been the cause of leprosy.Leprosy in Foreign Countries, Honolulu, 1886, pp. 33,.37,39.
Surgeon-Major Geoffry C. Hall, Allahabad, in a communication to the Indian Medical Record, says : "Is there any cure for leprosy? I reply, No. Can leprosy be mitigated? I say decidedly, Yes. But the fact remains, once a leper, always a leper. .
With regard to the vexed question of contagion, I am of opinion that leprosy is inoculable. . . . There is the fact that leprous sores do heal in a great many cases without any treatment whatever. . . . But these sores healing do not, as so many people imagine, mean that the leprosy is cured, but merely that a local manifestation has been cured; the leper remains a leper,. and sores will certainly occur at some future period.
All the remedies seemed to be equally inefficient. Nerve remedies had, I presume, altered nerve tissue to deal with, therefore they could not act in their usual way. The much bepraised resorcin and icthyolin were as useless as all the others, and the conclusions I have come to are :(1) Lepers should be well fed; (2) kept scrupulously clean; (3) have some inunction to keep the skin soft; (4) have their sores treated on rational principles. Then their lives are made less burdensome to them, and they are comparatively happy. The remedies used were strychnine, phosphorus, arsenic, mercury, potassium iodide, chaulmoogra oil, resorcin and icthyolin, gurjun oil, neem oil, and strychnia, and sweet oil with chaulmoogra oil and gurjun oil internally. I made sketches of some of the patients I treated, with remarks made during the course of treatment. I treated in all fifty patients, with in no case any marked benefit as regards the cure of the disease."Calcutta Daily News,. November 3, 1891.
In an article on "Leprosy in Kashmir," by Ernest F. Neve, M.D., F.R.C.S., Ed., I find that, "as treatment, iodoform, iodide of potassium, mercury, arsenic, quinine,. phosphate of soda, and mudar root, have been tried internally; while balsam of Peru and gurjun oil have been rubbed on externally. Carbolic, acid and iodine has been used for wounds. Nerve stretching has been adopted for anaesthesia and trophic ulcers. None of these is a specific."Lancet, 16th November, 1889, p. 1000.
The British Medical Journal, August 10, 1889, contains an article, entitled, "Clinical Notes on Leprosy," by James J. L. Donnet, M.D., Inspector-General of Hospitals and Fleets, Honorary-Surgeon to the Queen. Under the head of "Treatment" is the following (p. 304):"In the treatment of this disease the hygienic, the dietetic, and the palliative had more influence than the therapeutic. Where the cleansing of the skin by baths could be effected; where soothing or stimulating applications were made to ulcerated surfaces and to skin, to delay the distressing symptom of prurigo; where good and abundant food was given, fresh air obtained, and exercise without fatigue, taken, with attention to full ventilation of inhabited rooms; where measures were adopted to afford recreation and gentle excitement, and thus divert the mind from the disease itself, a marked difference and a decided improvement, were the consequence. Under these influences the disease made little advance. But it is one that follows a determined course, rapid in some, more dilatory and seemingly stationary in others, but never retrogressing, always advancing."
"Where drugs are administered internally, I remarked that only those possessed of dietetic propertiesas, for example, cod-liver oilwere of any value. Mercury, arsenic, iodide of potassium, assacil (obtained by incisions into the bark of the hura braziliensis), ammonia, and other preparations, each acted on the system, modo suo, but not in the measure or way hoped for."
Dr. Max Sandreczki, in an arficle entitled "A Study on Leprosy," in the Lancet, August 31, 1889, p. 424, says:"As to the possibility of cure, one may say without fear of contradiction that among adults it is excluded.". . .
"The discovery of the bacillus has not hitherto advanced the curing of leprosy. Neither the transmissibility nor the mode of propagation has been demonstrated. Unfortunately, we are not permitted here to make dissections, and it is almost impossible to procure objects for the microscope. In conclusion, I would remark that if the bacilli cause leprosy, and propagate it from one person to another, how can we explain the long latent periodthe repose of the bacillus for years? Is it not probable that the human body, more and more degenerated by years of misery and by every sort of hurtful influence, becomes the soil favourable for the development and culture of the bacillus?"
In a discussion at the Royal Medical and Chirurgical Society on the cure of leprosy, Mr. Macnamara, the author of" Leprosy a Communicable Disease," observed that "he had never seen a case which he could regard as being even relieved by treatment." The Lancet, May 31, 1890.
Dr. Thin, under the head of "Treatment," p. 203 etseq.,. observes that iodide of potassium has been experimented with by Danielssen on a large scale. It always produces a more or less violent eruption of nodules with feverish symptoms. Dr. Thin adds: "It affects patients both as a powerful poison and as a means of cure." After devoting several pages to recording experiments in drug medications by Dr. Unna, which must have caused much suffering to the hapless patients, Dr. Thin observes :"Alas, that strenuous exertions directed with such intelligence and experience, should after all have turned out fruitless! The bacillus, however, remains apparently uninjured; and, although the treatment does not save the patient from his inevitable fate, Dr.. Unna has done good service in making such an exhaustive experiment with strong drugs that had not been sufficiently tested previously."Leprosy, by Dr. George Thin, 1891, p214.
Dr. Andres Navarro Torrens, Physician-in-Charge of the Provincial Hospital, Las Palmas, Canary Islands, writes to me, 1889:" I have not up to this day seen any positive and evident cure by medicinal treatment."
A communication from the Superior Council of Health, Mexico, says :" In the medicinal treatment there have been employed, successively and without result, mercurials, hydrocotila sciatica, guano, yodadurados, arsenic, sarsaparilla, and tarantula, as diaphoretic measures."
"The therapeutic as well as the dipterocarpic methods of treating the disease have been hitherto ineffectual." Leprosy in Foreign Countries, 1886, Honolulu, p. 186.
Dr. K. Yamamoto, surgeon on board His Imperial Japanese Majestys ship "Rinjio," in a communication to the Honolulu Press, June 19, 1883, describes leprosy as an incurable disease.
A communication to the Hawaiian Government from the Faculty," Barcelona, Spain, in reply to an inquiry as to the results of medical treatment, says :" A great number of medicines have been tried to combat this disease, but, in almost all cases, without result."Leprosy in Foreign Countries, Honolulu, 1886, p. 194.
Dr. Kaurin, Medical Superintendent, Leper Asylum, Molde, Norway, says that "hitherto no specific remedy for leprosy has been found. At an early stage the disease may be cured by good diet and regimen; by careful nursing of the skin, baths, and symptomatic treatment."Journal of the Leprosy Investigation Committee, January, 1891.
After much careful reading, and inquiring into alleged cures in various countries, including those of Dr. Beauperthuy, of Venezuela; the remarkable results, reported by Colonel Chrystie and Father Muller in the Indian journals, *
*The latest communication I have seen from Father Aug-Muller, St Josephs Leper Asylum, Mangalore, S.C., where the Mattel treatment has been tried, appears in the Calcutta Daily News, October 30, 1891, and the writer only claims "amelioration in the health of the inmates," but no case of cure. This is no more than the natural result of hygiene without medicine at all.
of Count Matteis treatment the cures officially reported by certain foreign medical experts in recent Government reports of Hawaii; Dr. Kochs tubercular inoculation; and the nerve stretching and ulcer perforation at the Mucurapo Asylum, Trinidad, I find no evidence to warrant the belief in their ability to cure this disease. In every case the alleged benefit is only transitory, the tubercles and abscesses reappearing, often with increased malignity.
TUBERCULIN IN LEPROSY.
Dr. P. Ferrari, in an article on "Kochs Tuberculin in Leprosy," says :" Dr. Ferrari gives the conclusions of several observers who have experimented with the tuberculin in leprosy. Dr. Danielssen considers (1) that tuberculin in leprosy gives general and local reactions, the former generally coming on four to six hours after the first injection, but sometimes in twelve hours, and rarely in two to three daysthe local reaction is more tardy; (2) that unfavourable consequences ensue to the patient, the disease being aggravated, and that the reactions have some similarity to those produced by the preparations of iodine in lepers; (3) that the lymph does not kill the bacilli, but seems instead to give them nutriment and favours their reproduction and circulation in the blood; (4) that when immunity to the remedy is established the disease is in no way arrested, nor the bacilli destroyed. Dr. Ferrari has himself come to the conclusion, from the consideration of the above cases and of those of other observers, that tuberculin exhibits no direct useful action on the leper. As in tuberculosis, it may act on the torpid condition of the tissue, not so. much by any specific effect as on account of the small resistance of the diseased tissue. He remarks particularly on the outburst of new tubercles during the paroxysms of fever."Journal of the Leprosy Investigation Committee, No. 4, December, 1891, pp. 46-47.
Dr. J. L. Bidenkap, Physician to the Department for Skin Diseases, Rigs Hospital, and Lecturer on Dermatology at the University of Christiania, Norway, says,. under the title of "Curative Treatment:"" There has been searched in vain for remedies which have a direct favourable influence on the disease, or specifics. Mercurial preparations have, of course, been tried to a considerable extent. They have, however, but little or no influence on the disease, and often do harm. The reported few favourable results, or even recoveries, of the employment of these agents have possibly been due to accident, or in some cases to an erroneous diagnosis, the disease having been confounded with syphilis. The same is also the case with iodine preparations, which, according to the experience of Danielssen, are liable to evoke acute outbreaks, and on the whole are hardly advantageous, any more than bromine combinations. Antimonial preparations, and particularly tartar emetic, have, among others, been tried by Danielssen in increasing doses for long periods, but, it seems, without notable effect. Arsenic seems to have little or no influence, and this applies to most remedies of the same class. Of vegetable drugs there are a great many which have been vaunted as specifics at the places where the people understood to gather and to use them. In the European hospitals, however, these remedies have proved more or less inert. I have used salicylic acid for long periods of time; but, contrary to the experience of others, I have seen more harm than benefit from the use of it."
"Of therapeutic remedies it is mainly baths, tepid tub and steam baths, which seem to act favourably, and the general health of the patients often improves greatly by their methodic employment."Abstract of Lectures on Leprosy, 1886,pp. 65-67.
In a Report on Leprosy in New South Wales, Mr. Edmund Sager, the Secretary to the Board of Health,. Sydney, says :" In adopting the system of segregating cases of leprosy, the Board has had before it the fact that the disease is, so far as at present known, incurable, and that its efforts must be directed to prevent its reproduction or spread."
The Report of the Inspector of Asylums, Cape of Good Hope, presented to both Houses of Parliament, 1891, referring to leprosy, p. 30, says :" There is no reason to believe that specific treatment has in any case effected a cure. Gurjun oil, arsenic, potassium iodide, and icthyol have been tried without any result beyond what would be expected of healthy surroundings and good diet."
In the Report of the Select Committee on the Spread of Leprosy, Cape of Good Hope, under the head of "Minutes of Evidence," July 1889, I find the following:--
Dr. W. H. Ross, Police Surgeon at Cape Town for twenty-two years, under examination
Q. 323. "During your stay at Robben Island has it ever been seriously attempted to treat leprosy as a disease in the same way, as any other disease would be treated at a public hospital or asylum?""We endeavour to alleviate their sufferings, but very little can be done, except to treat symptoms and complications as they arise in this incurable and hopeless malady."
Dr. H. C. Wright testified
Q. 21. "Leprosy is a disease for which as yet we have found no cure."
Q. 33. " Have you had any experience of the remedies tried for the cure of leprosy? ""I do not know of any cure."
Q. 36. "You are, however, of opinion that leprosy is incurable ? "" I do not think that we have found any specific for it. I think all authorities are agreed as to that."
Dr. Beck testified
Q. 176. "Leprosy cannot be cured, the disease must run its course, and the patient dies."
Dr. J. H. Cox testified
Q 227. "I believe that it (leprosy) is not curable."
The Report (page ix.) says :" In the anaesthetic form of the disease there is not much actual physical pain, but in that as well as in the tubercular form the patient undergoes a gradual physical and often moral decay which renders him an object peculiarly deserving of the compassionate care of the State."Cape of Good Hope, Report of the Select Committee on the Spread of Leprosy, July, 1889.
As to therapeutic means, Dr. Alexander Abercromby observes :" The animal, the mineral, and the vegetable kingdoms may be said to have been ransacked. By some the chloride of mercury and the bichloride, in combination with sarsaparilla, have been highly extolled; whilst others, relying more upon antimony as a curative means, have given it as their opinion that mercury is positively injurious. In large doses all seem to agree that it aggravates the disease."Thesis on Tubercular Leprosy, p. 20.
The same authority, writing April 20, 1892, from Cape Town, in a letter to myself, says :" After more than thirty years experience as regards the treatment of the disease medicine makes no impression upon it even in the earlier stages."
In a Special Report on Leprosy from Robben Island for 1891, Dr. S. P. Impey, Medical Superintendent, says :" A good deal is said and done when small-pox threatens our country, but how much more dreadful is leprosy than small-pox. Small-pox may kill hundreds in a few days, but all who suffer do not die. Leprosy is fatal in all cases, and all who once catch it, after lingering for a few years a life worse than death, shunned by all, they become outcasts, with no hope of cure before them, and die objects of abhorrence and pity."Reports presented to both Houses of Parliament by Command of His Excellency the Governor of the Cape of Good Hope, Cape Town.
The Lancet, of April 16, 1892, has a leading article on the results of this mode of treatment of leprosy Referring to the experiments of Dr. Danielssen (of Norway), it says :
"The injections were made daily, unless the reactions were severe, when an interval of several days was allowed. In some of the cases the treatment had to be stopped even when only small doses had been reached, because the eruptions in the tuberculated and in the anaesthetic cases became so intense that the disease was evidently aggravated." . . . Drs. Babes and Kalindero, of Bucharest, treated seven patients with inoculations of the same material. Upon these the Lancet observes: "Unfortunately the conclusion drawn was that tuberculin aggravated the disease considerably, and, by setting free the bacilli, started fresh foci of the disease, and made the whole process more active.
As in lupus and phthisis, the patients became tolerant of the tuberculin after a time; but the disease progressed all the same, and fresh symptoms were frequently excited, lesions became red and sensitive In the anaesthetic form the patches enlarged, became redder and more sensitive, and new patches appeared" Dr Colcott Foxs patient, treated by Mr Cheyne at Kings College Hospital, seems to have fared no better. The Injections (of tuberculin) "were followed by severe pains in the ulnar nerves, and in the calves and knees, with a temperature of 103° F. After the fourth injection extreme dangerous collapse followed the reaction, the eruption more prominent and large blebs formed on both feet, and t were other unpleasant symptoms. . a purely non-tuberculated case of long standing which was almost quiescent, obscure pains at intervals being the only symptoms left; the injections therefore had obviously excited a neuritis and revived the typical macular eruption which had faded away." . . . In one case (treated by Dr. Goldschmidt, of Madeira), "intense and prolonged reaction ensued, followed by blebs and new swellings of skin and mucous membrane, while on the lower limbs absorption of the leprous infiltration was produced." . . ,, "Mr. Cantlie, of Hong Kong, used it (tuberculin) in seven cases, and he also found bacilli in the blood after injection, there having been none there before." . . . "In Dr. Radcliffe Crockers case a single injection of two milligrammes excited an attack of leprous fever, which lasted three weeks. Scores of new tubercles came out all over the body, but under gurjun oil inunctions they all disappeared again, and there was a little less infiltration in some parts. The patient, a tuberculated leper, had previously improved considerably with large doses of chaulmoogra oil, and had had no febrile exacerbation for two years prior to the injection. As an ultimate result he was not really any worse; but three weeks fever was a long price to pay for a single injection, and be did not care to have it repeated."
"The above cases do not exhaust the list of experiments, but they are sufficient to show that tuberculin is very uncertain in its immediate effects on leprosy; that while in some it produces no reaction or effect at all, in others, even with small doses, considerable and prolonged reaction may ensue; and that therefore not more than one milligramme should be given at first, and cautiously increased according to the patients toleration of the fluid. Secondly, that it revives the activity of cases which have been quiescent for a long time, producing neuritis, bringing fading rashes into prominence, exciting bullae, and setting free the bacilli; these may get into the circulation and produce fresh cutaneous and other lesions. In the ultimate effect, while some patients have shown improvement that has not been proved to be permanent, and in some was certainly only temporary, on the whole the position may be summed up by stating that, as far as the results hitherto obtained are concerned, the improvement which may result is too uncertain, too limited in character and time, and purchased at too great a risk of aggravation of the disease by the dissemination of new foci, for it to be recommended as a treatment for leprosy; and although some of Dr. Hunters or similar modifications of tuberculin might lessen the immediate disagree able effects, the fact of its action being to set free bacilli rather than to destroy them should make us seek in another direction for remedial agents for the relief of victims of this much-dreaded disease."
It is admitted that lepers suffer acutely from neuralgic pains, which Dr. Sidney Bourne Swift says "are common amongst lepers of all types;" and the wretchedness of their condition is intensified by the drastic treatment adopted at many of the hospitals and lazarettos. The application of Kochs tuberculin is often attended with excruciating pains.
Under the head of "Cantharidin Treatment in Leprosy," the British Medical Journal, September 5, 1891, says:" The injections caused severe pain, but no local reaction; they were, however, always followed by a rise of temperature in the leprosy cases."
The writer, when visiting a leper hospital a short time ago, was witness of the fashionable inoculative experimental treatment. The poor creatures were brought into the surgery one after another, some brave and others with a timid, appealing look in their eyes. To enable them to bear the pain of the hypodermic syringe, thrust by the operating physician deep into the flesh, they had a handkerchief between the teeth while held by the hospital nurse or attendant. The puncture of the instrument is usually the least painful part of the experimental process. The treatment, which is often continued for months, produces sickness, acute headaches, and fever.
The rage for experimental research has long since passed the bounds of decent humanity, and many who have investigated the facts are of opinion that legislation ought to be specially invoked in the interest of these, the most hapless members of the human family. It is a common experience for lepers in hospitals to attribute the aggravation of their maladies to therapeutic treatment in the hospitals, and this is confirmed by high medical authority.
In the report on "Leprosy and Yaws in the West Indies," by Dr. Gavin Milroy, London, 1873 (c. 729), the author observes:" It struck me forcibly, on observing the persistency of the an~mic condition of so many patients at Kaow Island (the Leper Settlement of British Guiana), and still more of Dr. Beauperthuys three private patients at Bartica, that this symptom was in part due to the prolonged use of a medicine, which is found to be notably injurious in like conditions of the system in European practice." From the foregoing testimonials (and others which I have not space to adduce), confirmed by my own observations and inquiries, it appears to be the general experience that leprosy attacks most readily those whose vitality is reduced by malarial fever, syphilis or insanitary conditionsi.e., unwholesome food, and impure water, and is most speedily fatal to those unfortunates at the hospitals who have been selected as subjects for inoculation experiments, mercurial treatment, and other drug medication. Whatever benefit patients have obtained is admitted, by the highest authorities in all the countries I have visited, to have been due solely to improved sanitary conditions and hygienic treatment. One thing is certain, the unfortunate patients dread the experimental treatment to which they are subjected by lepra experts, often escaping from lazarettos .and secreting themselves in the gullies and fastnesses of the hilly regions and in the jungle to avoid the terrible ordeal to which they would probably be subjected.*
*Dr. George L. Fitch, formerly Medical Superintendent, Leper Settlement, Kalawao, Hawaii, says: "On November 14, 1883, I inoculated six lepers with the virus of syphilis, by taking ivory vaccine points, and scraping off the surface of a mucous patch on the inner side of the lower lip of a native woman. The points were then allowed to dry, and three hours afterwards I transferred the virus to the arms of six leper girls under twelve years of age. December 14 following I repeated the experiment, taking the virus from a hard chancre on a Portuguese who came to my office. I saw this man in March, 1884, three months later, in the office of a brother physician, and found he was suffering from secondary syphilis. The last time I used fourteen points and inoculated fourteen lepers therefrom, but no result followed in any of the twenty experiments."New York Medical Record, September 10, 1892, p. 297.
It is acknowledged that there is no specific for leprosy, nor is there any drug which has permanently ameliorated the condition of the patient. Where gurjun, chaulmoogra, or other oils have been used externally there is a temporary alleviation, probably due to the massage or friction employed, but the disease, when it once has taken hold of the system, is absolutely unamenable to therapeutic treatment. On the other hand, there appears to be a consensus of opinion that, in the majority of cases, the condition of the lepers may be improved, and life rendered more tolerable, by their removal to a salubrious locality, with wholesome food, cleanly and orderly habits, cheerful recreation and employment for body and mind, and that under these conditions the disease may in rare instances die out. The worst picture of concentrated and hopeless misery I have ever seen was in 1884 in the Lazaretto of Damascus, where all these essentials were wanting. In view of these experiences, which can be multiplied to any extent, and on the ground of humanity, is it not time to put a stop to the torture to which the incurable sick lepers are subjected by drug medication and inoculation, and let these miserable creatures be made as comfortable as tender nursing, varied occupations, and amusements will allow, and permit them to die in peace? Not a few of them are the victims of the Jennerian system, and these are the smallest compensations we can make for the irreparable injury done to them.
Above all, we can cease to propagate this fell disease. We can discontinue the enforcement of a medical practice which experience has shown to be a potent factor in its dissemination. This is the most terrible count in the long indictment against vaccination; but, as I have shown, it is amply sustained by the testimony, often unwilling testimony, of unimpeachable witnesses of the highest credit and authority. It may perhaps be thought that what I have quoted is only ex parte evidence, that possibly an equal array of high authorities may be cited on the other side. This, however, is not the case. There is here no conflict of testimony, so far at least as inoculation is concerned, and vaccination is one and the chief means by which inoculation is effected. If there are authorities of equal weight to be thrown into the opposite scale, in my careful personal inquiries and patient investigation into the subject I have not discovered them.