100 REVIEW — TROPICAL MEDICINE, ETC. 



Leprosy — 2. Leprosy now prevails extensively in Southern Chin.a and is unknown, for the most part, in the North. 



coiUititied 3. Husband and wife scarcely ever suffer together. 



4. The medical officers and nurses of leper asylums never contract the disease. 



a. In all leper asylums there are a certain number of inmates who have been admitted under erroneous 

 diagnosis. These often remain there for years, yet they never acquire leprosy. 



6. The lepers who are brought from abroad into England and Northern Europe never become sources of 

 infection to others. Further, it docs not seem probable that the prick of an insect should convey a disease 

 respecting which carefully-conducted experimental inoculation always fails. Moreover, leprosy never shows any 

 primary sore. 



Turning to other aspects of the question, an analysis of 220 cases of Sudanese leprosy 

 by Tonkin' is of special interest to us here. The Central Sudan, i.e. the region about 

 Sokoto, Kano and Kuka is that concerned. In many ways the habits aud customs of the 

 races inhabiting this part of Africa appear to be identical with those of the people of the 

 Anglo-Egyptian Sudan, and to anyone anxious to work out the leprosy problem in the latter 

 country, a perusal of Tonkin's paper is indispensable. In a summary he shows that the age 

 of onset seems to work out earlier for the Sudan than in some other exploited areas, but he 

 notes that this may be due to some special local conditions which have escaped attention. 

 He says little about recovery from the disease, but indicates that in the Central Sudan as 

 elsewhere there is evidence to show that it occurs and that this question is one meriting 

 more attention that it has yet deserved. 



The history of his cases does not support the factor of heredity as being instrumental 

 in the production of the disease and he brings forward arguments against it, for example : 

 leprosy is a disease which reacts prejudicially on propagation, hence it is not likely to derive 

 support from a factor that is hereditary. As regards predisposition, he shows that leprosy 

 has occurred in many people who have had no leprous ancestors. He believes deficiencies 

 of diet have a great deal to do with it, coupled with faulty hygienic principles as regards 

 clothes and bedding. He says that wherever leprosy occurs we have habits with regard to 

 clothes and bedding which are open to criticism and stereotyped national diets which leave 

 much to be desired. He remarks that in the Central Sudan the communistic way in which 

 unwashed clothes are handed about must have a direct influence on the spread of leprosy, 

 and that a diet in which the carbohydrate elements are represented to an extent which 

 disturbs the proper proportion of the nitrogenous would appear to handicap races reared on 

 it in their fight against the disease. He does not, however, believe that an ill-assorted diet 

 will cause leprosy or that the disease cannot be contracted without the intervention of such 

 a diet. Still he does maintain that in the Central Sudan the most frequently operating 

 factor, not in causing the disease but in assisting to determine its incidence, is that of a 

 badly balanced and, therefore, ineflBcient diet. 



It is worth noting that fish is recorded to be dear and, therefore, consumed by the 

 masses of the country even to a less extent than meat, which is by no means a staple form 

 of food. Salt throughout the whole country is scarce and dear. 



These latter paragraphs lead us into the realms of controvei'sy, and though it is, of 

 course, impossible to quote fully from the literature which has accumulated regarding the fish 

 theory of leprosy so ably and ingeniously put forward and tenaciously supported by 

 Jonathan Hutchinson, reference must be made to several of the more interesting recent 

 papers available. 



The whole subject is considered in a review- of Hutchinson's work " On Leprosy and 

 Fish Eating : A Statement of Facts and Explanations." Hutchinson's theory is that the 

 fundamental cause of true leprosy is the eating of fish in a state of commencing 

 decomposition. The cause of the disease is, in his opinion, some ingredient or parasite 

 generated by, or introduced into, fish which has been either not cured at all or cured badly. 

 As a result, it is maintained that segregation of lepers will not stay the disease. 



So long as the food is not taken from the hands of lepers it is asserted that there is no 

 danger from consorting with them. 



The various arguments brought forwai-d to prove the fish theory are detailed at some 

 length, such as the irregularity of the distribution of leprosy and the fact that a very large 

 number of lepers are found in all countries who have neither inherited the taint nor been in 

 any way exposed to contagion. 



• Tonkin, T. J. (April 18th, 1903), " An Analysis of 220 Cases of Sudanese Leprosy." Lmicct, p. 1077, Vol. I. 



^ Hutchinson, J. (June 16th, 1906), " On Leprosy and Pish Eating : A Statement of Facts and Explanations," 

 Review in Lancet, p. 1095, Vol. 1. 



