25- 



by which a disease which was spreiHins.' solflv hy 

 contagion would be exteriuiuatfd. It misjlit 

 further bs urged that wh."!! the disease wis de- 

 clining, and it became difficult to find sufficient 

 inmates to till the homes, then in almost all 

 instances others as well as lepers were admitted. 

 Had it been contagious this would have been a 

 certain means cf perpntuating it. At this point 

 the lecturer proceeded to make some important 

 statements as to the communicability of thedisease. 

 « He said he did not believe that it could be com- 

 r municated b.v the breath or by the touch. Doctors 

 \ and nurses who attended on lepers never caught it, 

 I and all experiments as to its Communication by in- 

 \ oculation h«dfailed. Nothing was less common than 

 for husband and wifet'> have the disease together, 

 and the cises were innumerable in which married 

 couples hiid continued to live together. Yet there 

 was a widespread belief that the disease might be 

 communicated, and that belief he (M.-. Hutchin- 

 son) feltsure was well founded. The mode of com- 

 munication wa^, however, in all probability very 

 peculiar. He believed that it was solely by eating 

 food directly from a leper'.s hands. In this way the 

 parasite might be taken into the stomach juot as 

 it might by eating tainted i3sh. We all admitted 

 that the tubercle bacillus might be received in 

 milk or meat, and it was exceedingly probable that 

 the bacillus of leprosy followed parallel modes of 

 life. If this suggestion of what we might call 

 commensal communication should be accepted, it 

 would satisfactorily explain all that had hitherto 

 been so apparently contradictory as regards the 

 contagion of leprosy. It would explain why 

 amono-st grown-up people and careful feeders the 

 disease never seemed to be communicable, and why 

 every now and then under quite other conditions 

 it did spread. He (.Mr. Hutchinson) had recently 

 returned from a tour in South Afiica, undertaken 

 in order to investigate the facts as to leprosy in 

 Cape Colony and Natal. It was theie that be had 

 become quite convinced that the disease did spread 

 from person to person, for he had found in Kaffir 

 kraals young persons affected who bad certainly 

 not inherited it, and who had never eaten salt- 

 fish. In all such cases the disease had been 

 introduced into the kraal by a Kaffir 

 labourer, who had been away into Cape Colony to 

 work. By him it had been brought home, and 

 from him ithrtd apparently spread. The spreading 

 was never to any great extent ; just a few cases ; 

 one or two affected and dozens apparently exposed 

 in equal degree escaping. Thus, we are justified 

 in believing that the mode of communication must 

 be very peculiar. Children are those most likely 

 to suffer from commensal communication, since 

 they are more likely than adults to be willing to 

 taVe ffKjd directly from the hands of tainted 

 persons. As a matter of fact, in Natal it would 

 appear that children were the chief sufferers. If, 

 indeed, leprosy wete communicable by the breath 

 or by the touch it would be far more common than 

 ( it is. There are more than a few lepers now 

 I resident in England, all of them imported cases, 

 and no attempts at segregation are ever made, yet 

 I the disease never spreads. No case has originated 

 \ in England for n. arly two centuries. The same 

 J Btatemeits are, with little modification, true of 



France, Germany, Denmark and the United States. i 

 The diWase, however, still bold.s its ground in I 

 Norway and Iceland, in Spain and in Portugal, and ' 

 in various places in the Mediterranean, whilst it is, 

 as all knew, very common in China, India, Ceylon, ) 

 and the West Indies. As regards Norway and 

 Iceland they are places where salt-fish is very 

 largely used, and from Norway large quantities are 

 exported for consumption in Catholic countries, 

 chiefiy in Spain and Italy, exactly where leprosy 

 still occurs. During the periods of the decline of 

 the disease in the British Islands it receded first 

 from the central districts and lingered longest in 

 Cornwall and the Shetland Islands, places where 

 fish was very largely consumed. The intioduction 

 of potatoes was credited as a cause for its dis- 

 appearance from Ireland. The progress of the 

 disease in South Africa had been of extreme 

 interest in reference to the fish hypothesis. There 

 was good reason to believe that the disease had 

 been" almost, if not entirely, unknown amongst 

 the Hottentots, and it was quite certain that 

 Kaffirs were free from it. The Dutch founders of 

 Cape Town took over a batch of Miilays to fish in 

 Table Bay, and to cure fish for the use of the 

 Colony. A century and a half ago tliree Dutch 

 residents near to Cape Town were found to be 

 lepers. This was at a time when salt-fish was 

 freely used. During the next half century the 

 disease spread chiefly amongst the Hottentot 

 slave labourers but in part amongst the Dutch 

 themselves. Salt fish and rice was the food which 

 the slaves had almost solely to eat. For long the 

 disease was restricted to the districts near to 

 Cape Town. Mossel Bay, Kalk Bay, Saldanha Bay, 

 and other fishing places at no great distance. It 

 became necessary to found leper houses, and 

 the first of these was near Cape Town. 

 As roads were made and intercourse developed, 

 however, the disease spread slowly and 

 sparingly inland. It spread to the north and to the 

 east, and quite recently it had crossed the 

 Drakenberg Kidge into Natal, on the eastern 

 seaboard. There had recently been leper homes 

 established at Pretoria and BJoemfontein. Thus 

 South Africa is now repeating the experience of 

 Europe \n the twelfth ceutury, and much anxiety 

 is very naturally felt. Now the kind of .salt-fish 

 in use amongst the agricultural and mining 

 labourers of South Africa is a very bad kind. It 

 is what is called sack-fish, because it is sold in 

 sacks. It is very imperfectly salted. The belief 

 that leprosy dnpends upon the eating of salt fish 

 badly cured is based upon circumstantial evidence. 

 The bacillus has never been discovered in fish. 

 Nevertneless the evidence is very strong, and to 

 anyone who has energy to grapple with the facts, 

 and memory enough to keep them all in mind 

 together, it will probably he quite convincing. 

 The experience of the Middle Ages proves that 

 the malady, although very common, may die out 

 and absolutely leave whole countries and districts. 

 No one conversant with the facts can believe that 

 this result was attained by segregation. It fol- 

 lows, then, that there must have been someagency 

 at work which gradually ceased to he efficient. It 

 is useless to suggest that the change was the 

 increase of cleanliness and of general attention to 



