l6o PROC. COTTESWOLD CLUB vol. xiii. (3) 



larger portion of the earth's surface, the disease exists 

 with greater or less virulence. 



Numerous reasons have been given to account for the 

 existence and prevalence of leprosy in infected areas. 



1. It has been said that climatic influences afl^ect it. 

 But it exists as near the Arctic circle as Iceland, Norway, 

 and Siberia ; all during the Middle Ages it was most pre- 

 valent in temperate regions ; and then, as now, it existed 

 almost everywhere in the known Tropics. But in tropical 

 countries, where there are great fluctuations of temperature 

 and great moisture, the body becomes more or less ener- 

 vated, and there is a predisposition to specific disease ; 

 hence perhaps the prevalence in the Tropics. 



2. Again, it is said to be specially prevalent near the 

 sea coast. To some extent this is true, but only partially 

 so. In Syria, for instance, it is rare on the coast, and 

 prevalent on the mountains. Precisely the same remarks 

 apply to Madagascar. In India the chief centre is at 

 Rumaon, with an elevation of 5000 ft. above the sea. In 

 the Brazils it is terribly prevalent in many up-country 

 districts, and very much less so on the coast. It has also 

 been observed in all ages that there are certain spots or 

 limited areas where the disease may rage ; whereas imme- 

 diately outside these areas, though the conditions are 

 perhaps similar in every appreciable respect, there is 

 absolute or comparative immunity from disease. 



3. Again, it is a very common beHef that leprosy is 

 prevalent where fish, and especially salted fish, forms a 

 large part of the diet of the inhabitants ; but it is endemic 

 in many places where no fish is eaten, and it has disappeared 

 from many places where fish still continues to be largely 

 consumed ; and there are bad spots in the midst of large 

 fish-consuming districts, while there is exemption out- 

 side the limited affected area. In Central China fish is 

 essentially the food of the well-to-do, whereas the poorer 



