102 EBVIEW — TROPICAL MEDICINE, ETC. 



Leprosy — t'liiit is necessary to test the matter is to ascertain whether the iiicidonce o£ leprosy is co-extensive with 

 continued tl'c use as ;x food of decomposing fish. Such an expectation is doomed to disappointment. We read: "The 

 fish hypothesis assumes that it is probable that even in fish in a state of decomposition the presence o£ 

 the dangerous ingredient is exceedingly rare, but that a very .small quantity of fish contaiuiug it may 

 be efficient in the production of the disease. Thus the large or small consumption of fish has little to do 

 with the matter." In other words, Mr. Hutchinson has hedged, and the hypothesis as now enunciated by him is 

 incapable of proof or disproof, and his challenge of refutation he can make with perfect safety. The whole tenor 

 of the book shows that the author occupies towards his offspring the position of an interested advocate, and never 

 that of an impartial judge. The fish hypothesis is supported thus : As a general statement it is true that all 

 places where leprosy is now prevalent are either on the sea-coast or near to rivers or lakes ; all over the world it is 

 a disease of tribes which fish and not of those which hunt. It was very prevalent in Europe in the middle ages 

 and began to decline before the reformation, the conclusion reached being that its prevalence was due to the 

 eating of improperly dried fish on fast days, and its disappearance to the religious laxity which he assumes to have 

 preceded the reformation. He shows quite clearly that at that time isolation of lepers was not attempted. 

 Leprosy has not been prevalent in Russia because the Greek Church does not allow of the eating of fish on fast 

 days. It occurs more in men than in women, partly because men no doubt get an unfairly large share of the 

 decomposing fish food where it is an expensive luxury, and partly because men are dirtier feeders. Among the 

 Hawaians the appearance of leprosy, forty years after white men came among them, was coincident with the 

 establishment of a factory for curing fish. From Cape Town dried fish is distributed largely to the Malmesbury 

 district, a noted centre for lepra. Leprosy in Norway only occurs on a strip of the western coast where there is 

 little laud for cultivation, and fish is the principal article of food and is preferred tainted. There is a large export 

 of dried fish from Norway to Spain and from Newfoundland to Portugal, and there is much leprosy in Spain 

 chiefly along the north and south coasts. We should imagine that were there any value in this argument, the 

 incidence of leprosy in Spain and Portugal would follow the trade routes, and not be chiefly incident on the more 

 inaccessible north and south coasts. 



The large proportion of lepers in India who are Christians, he considers a proof of his hypothesis. We have 

 ascertained from the manager of a leper asylum with 200 inmates that nearly all the Christian lepers there have 

 become Christian since their admission into the asylum as lepers. There is one part of Mr. Hutchinson's argument, 

 which we do consider to be built on a basis solid and capable of being upheld, though we entirely dissent from the 

 conclusion drawn from the facts ; we refer to the inverse ratio between the abundance of salt and the incidence of 

 leprosy. The author gives the amount of salt required daily by an adult as from 300 to 400 grains, including that 

 present in the food ; he states that the development of the salt trade and the introduction of bettor kinds of salt 

 have often been coincident with the decline of leprosy in a very marked manner, that for example one great 

 difference between Northern and Southern China is that in the one salt is abundantly produced, and is an article 

 of export, while in the other it is imported and subject to tax, that iu the latter leprosy is abundant and in the 

 former unknown. He brings forward other statements of a like nature. Almost the whole of the salt used for 

 fish-curing iu Norway is imported, and we presume therefore dear, and that it is unlikely that the poor will get it 

 in sufficient quantities. It is worthy of note that it is precisely those parts of Europe which are the most 

 remote from the beaten tracks of commerce, and to which the importation of salt in common with other 

 commodities would be unsatisfactory, that leprosy has lingered longest. Doubtless no one predisposing cause 

 accounts for all the facts. In some places, probably the Sandwich Islands group is one of them, leprosy has 

 appeared recently because it has been recently introduced, and just as measles, having within comparatively recent 

 years been introduced into Iceland, the Faroe Islands and the Fiji Archipelago, has raged virulently among 

 hereditary unprotected races, so has leprosy in the Sandwich Islands increased by leaps and bounds, till 40 years 

 after its introduction, every fiftieth individual was a leper. Some, too, of the world-wide decline of leprosy may 

 probably be fairly put down to the natural decline of an epidemic disease in the course of years, one of the most 

 familiar examples of which is plague." 



Jennings^* notes that in Abyssinia there are some 8000 lepers, who can rarely, if ever, 

 have eaten fish, owing to the scarcity of the article in a country where, " during the greater 

 part of the year, many of the wells do not contain water, much less fish." 



An interesting paper on leprosy in Cape Colony is that by Black. ^ He also argues 

 against the fish theory as regards the Cape, and draws special attention to his observation 

 that the disease begins (how long after the implantation of the bacilli cannot at present 

 with certainty be known) as a small collection of round cells under the mucosa of some 

 part of the nasal cavity. Some of these contain bacilli which pursue some part, at any 

 rate, of their life-history in their interior. Their dissemination to distant organs appears 

 to be mainly by the blood stream, and these cells come to rest in situations where there 

 is a tendency to intermittent stasis or slowing in the fine capillary circulation. Hence the 

 lungs, brain and spinal cord, being furnished with a rapid, free and continuous current of 

 blood are practically exempt from the occurrence in them of leprotic granulomas. On the 

 other hand, just as we have in leucocythiemic conditions an infiltration and enlargement of 

 the liver and spleen, so we have such in leprosy by bacilli-containing leucocytes. 



In connection with the nasal-infection it is noted that one of the earliest signs of 

 nodular leprosy is a slight erythema of the skin about the root of the nose and eyebrows, 

 sometimes extending to the malar regions, and that with these slight signs extensive 



' Jennings, J. W., " With the Abyssinians in Somaliland." Quoted in Journal of Trorikal Medicine, 

 February 15th, 1908, p. 62. 



■^ Black, R. S. (April 28th, 1906), " Remarks on Leprosy in Cape Colony." Lane.t, p. 1167, Vol. I. 



• Article not consulted iu the original. 



