PART II.] Prevalence of Leprosy along the Nepal Frontier. 485 



The history of the Asylam gives no support to the doctrine that leprosy is a 

 contagious disease, but strong evidence to the contrary. The reverse has been stated 

 with regard to the history of the Asylum, but it will have been seen, from the information 

 elicited, that not the slightest foundation existed for such a statement. 



But with reference to the probable influence of heredity in the propagation of 

 leprosy, the facts elicited, and which may, we believe, be accepted as trustworthy, give 

 forth no uncertain sound. There can, we think, be no very substantial argument 

 adduced in the face of the figures which have been collected in connection with this 

 Asylum alone to contra-indicate the inference that hereditary taint exercises a most 

 important influence in the transmission of the pest. 



Taking into consideration, therefore, the prominent part undoubtedly played by 

 heredity, and the fact that the disease but seldom manifests itself until after puberty, 

 it is evident that any attempt at " stamping it out " by the compulsory segregation 

 of leprous persons would prove wholly impracticable ; for, as mentioned in the last 

 chapter, it would not only be necessary to segregate those suffering from developed 

 disease, but also those hereditarily disposed to it. How, and by whom, could the 

 predisposition be determined? It would, indeed, be even more important to secure 

 the latter class and such persons as are only manifestly affected to a slight extent ; for 

 it would appear that persons of this description furnish by far the greater portion 

 of the children who are, so to speak, potentially leprous, — time and circumstance 

 alone being required for the development of the disease. 



In intimate relation with this question is that of the probability or otherwise 

 of an increase in the prevalence of the disease amongst such a leprous community as 

 exists in Kumaon. Fortunately it would appear that, jpavi passu, with the active mani- 

 festation of the disease, a tendency to sterility is also induced ; moreover, the mortality 

 among the children of lepers (even among such of them as are bom before leprosy 

 has manifested itself in the parents) appears to be abnormally high, so that the probable 

 aggregate of the number of the offspring of lepers is to a very appreciable degree less 

 than that furnished by non-leprous individuals. It is therefore evident that unless 

 there be influnces other than heredity at work in the locality tending towards the 

 production of the leprous condition, no serious increment need be apprehended. It 

 will be our endeavour to ascertain on a future occasion whether any such leprosy-inducing 

 conditions can be detected in the specially affected localities. 



With regard to the latter, we have drawn attention to the fact that the malady 

 is far more prevalent along the Nepal frontier, a country in which a very large 

 proportion of lepers is found, and it is believed that no organised attempt of any 

 kind exists in it to relieve their sufferings. Indeed, the reverse is not uncommonly 

 stated. Under these circumstances it is, perhaps, not strange that these districts 

 should be exceptionally afflicted, especially when it is considered that the records of 

 the Almora Leper Asylum show that one-fifth of the total number of the inmates who 

 have received shelter since the institution was established have come from Nepal. 



