54 LEPROSY 



test cannot be considered final, because the disease had affected some 

 of his family. 



The fact that the Hansen bacillus is found in all lepers, when a 

 thorough examination is made, must for the present be accepted as a 

 justification of the belief that it is the causal agent. However, many 

 problems in the etiology of this disease remain unsolved. This bacillus 

 may be aided by some other causal agent or it may be infective only 

 in certain conditions or states of health or in certain deviations from 

 health. It seems safe to say that the evidence available at present 

 indicates that leprosy is a transmissible disease, but that it requires 

 more intimate contact for its transmission than most of the other bac- 

 terial affections. Its history, even when studied most superficially, 

 indicates its contagiousness. Such a colony as that at Bergen has 

 brought it down continuously for at least eight hundred years. When 

 a leper finds his way into a region where the disease has never been 

 known, it slowly spreads. In this way, cases have developed in Min- 

 nesota, Michigan, Iowa and elsewhere in this country. From Norway 

 the disease has been transplanted to the Baltic provinces of Russia, 

 where the number at present is estimated at more than one thousand. 

 In Finland there is a leprosarium which was established in 1355 and 

 in 1908 it housed 87. 



Avenues of Infection. Supposing that the disease first manifests 

 itself at the site of inoculation, there is reason for believing that the 

 bacillus finds its entrance through wounds of the surface. It is a 

 common observation in leprous countries that those who go barefooted 

 are more frequently attacked than those who wear shoes, and that the 

 first recognizable lesions are on the feet. Two French physicians 

 report that among 2,437 cases under their observation in Cochin- 

 China, 526 were general from the start, 550 showed the first lesions on 

 the feet, 420 on the hands, 321 simultaneously on feet and hands, and 

 337 on the face. It is an old belief that infection frequently develops 

 in the nose. Heiser found nasal ulceration in 799 out of 1,200 cases 

 and others have reported even larger percentages. In recognizing this 

 disease, one of the first things to do is to stain the nasal secretion 

 of the suspected person for the bacilli. Among the healthy associated 

 with lepers the bacilli are frequently found in the nose. There is 



