EEVIEW — TROPICAL MEDICINE, ETC. 101 



The conditions under which the disease has declined in certain countries and has held Leprosy- 

 its ground in other countries are cited, New Zealand, Spain and Crete being examples of continited 

 the latter state of things. In Norway, leprosy is limited to fishermen, boatmen and 

 peasants, whose staple food consists of milk and the products of the sea. Peasants inland, 

 who suffer, have free access to fish food during its conveyance from the sea. 



As the majority of observers do not accept Hutchinson's deductions, the arguments 

 against them in this review may be given in full : — 



It must be confessed that this interesting theory does not meet with the approval of a large number of 

 physicians who have had personal knowledge of the disease. Let us note some of the objections to it. And first 

 as to bad fish being the essential factor. Should any cases be shown to exist where bad fish has not been the 

 essential factor, it must follow that the theory falls to the ground. Are there such cases ? We have seen that the 

 author explains the decline of leprosy amongst the Maoris to the fact that they have changed their diet to one of 

 meat, potatoes and bread. Now Dr. Francis Day, whilst travelling in Burmah, never saw a case of leprosy 

 amongst the indigenous population, although the Burmese like fish, and especially the odoriferous " nga " fish. 

 Dr. Vincent Richards, a man of acknowledged authority on tropical subjects, shows by statistics not only that the 

 consumption of fish has nothing to do with leprosy as regards its causation, but he also states that it would be 

 quite as logical to state that this factor is a prophylactic, the disease being less met with in those districts where 

 there is the greater consumption of fish ; and lastly. Dr. Crane, the Government physician in Hawaii, has written 

 that from time immemorial fish, especially raw fish, had been the staple food there until the year 1860. Until 

 that year there were no lepers in Hawaii nor was there any history of the disease. At this date it appeared, and 

 in a few years after its introduction it had decimated the community, yet at this time canned foods, fresh meat, 

 and vegetables had been very largely substituted for fish in the diet, and the use of fish, especially raw fish, had 

 enormously decreased. The history of Hawaii, in fact, demonstrates this fact, " all fish, no leprosy," " little fish, 

 no leprosy," and the argument is as valid as that used by the author in the contrary sense, concerning the Maoris. 

 Again, experience in India demonstrates the fact to the physicians in that country that many lepers declare, not 

 only that they have never eaten fish, but that they actually do not know what it is. Caste ordinances, again, 

 militate against the use of fish in many who have become lepers. 



Let us consider, also, the question of contagion. How can the fish theory explain the cases shown by 

 Dr. Benson at the Dublin Medical Society in 1872 and 1877 ? In 1872, a leper was shown by him who had 

 acquired the disease in the West Indies. In 1877, Dr. Benson showed a second case in the person of the brother 

 of the first, who had never been out of the United Kingdom. This man had slept in the same bed with his 

 brother and occasionally worn his clothes. Consider, again, the case mentioned by Professor W. Osier. Here 

 seven people were in turn affected by what to most minds must seem to have been contagion. And in connection 

 with the question of contagion, the remarks of Von Duhring are peculiarly apposite — namely, that all negative 

 evidence brought forward as to its non-communicability is valueless in the face of one positive fact. Lastly, as 

 regards the alleged failure of segregation to prevent the disease, few of those who have had personal experience 

 will agree with the author. To mention one instance only, in Madagascar the former limited amount of leprosy 

 has rapidly increased since segregation was abandoned. It is thus seen that there are many objections to 

 Mr. Hutchinson's theory which must be overcome before it can be finally accepted as the true explanation of the 

 disease. 



Indian experience is also adverse, as evidenced by another review' which we quote at 

 some length, partly because the arguments used appear to be very sound, and partly 

 because one has been specially asked to furnish information on this subject as regards the 

 prevalence of leprosy in certain parts of Kordofan where there are lakes containing fish. 



After pointing out that the important question of personal immunity is wholly ignored 

 in Hutchinson's work, the reviewer says : — 



Passing now to the consideration of the fish hypothesis itself, we find that the chief reasons for which fish is 

 considered to be the article of food responsible for the propagation of leprosy are these. Granting that it is due 

 to an article of food, it must be one which is of universal use and which has the same quality in all lands. There 

 is no vegetable met with in all the districts affected by leprosy ; the vehicle is not milk, for some races, the 

 Tartars for instance, almost live on milk and yet have no leprosy, and there are many leprous centres where milk 

 is almost or wholly unknown ; while of flesh foods there is no reason to suspect that of animals and birds. We 

 may note that the author has not taken into account the most widespread article of food, namely, salt. All places 

 where leprosy now prevails (he continues) are either on the sea-coast or near to rivers or lakes, except in the case of 

 India, and this exception he considers as probably not so great as it at first sight appears. The disease is of such 

 special and emphatic individuality that it can have but one and the same cause. That cause is in nineteen- 

 twentieths of its instances fish, and respecting the twentieth he considers that despite defects in evidence the 

 inference is justified that it is fish. But, we point out, the cause is, in all cases, the bacillus, irrespective of its 

 vehicle or point of introduction, and the same bacillus will produce the same reaction in the human being in 

 whatever way it may gain entrance to the tissues. As regards the kind of fish which is considered to cause the 

 disease, one finds from scattered references up and down the book that although salt fish is constantly spoken of as 

 a cause of leprosy, this is not what is really meant. Properly salted fish is looked upon as perfectly safe. The 

 article which is considered to be the cause of leprosy is fish in an early stage of decomposition, either from not 

 having been preserved at all, or from having been merely dried or improperly salted and subsequently eaten 

 uncooked. We believe that in one place only in the book (page 49) is it stated that it is uncooked fish of the 

 character just stated which is considered responsible for the transmission of leprosy, and although much space is 

 devoted to the attempt to prove that leprosy is associated with the ingestion of decomposing fish, no attempt at 

 all is made to show that the fish is uncooked or imperfectly cooked. Having followed the argument so far, the 

 conviction occurs that here, at all events, is something which is capable of proof or disproof, seeing that all 



' Hutchinson, J. (August, 1906), "On Leprosy and Fish Eating." Review in Indian Medical (Jazettc, p. 327, 

 Vol. XLI. 



