784 
PROCEEDINGS OF SECTION I. 
susceptible of it. Now, therefore, I must make further reference to 
the report of the Leprosy Commission in India, from which I have 
already drawn important details, although I find myself unable to 
accept all its conclusions. 
The Commissioners espoused a theory of maintenance by indirect 
communication, which I have already mentioned; and probably they 
were aware of the difficulty I have just pointed out — that either there 
was in reality no good evidence of the spread of lepra by importation, 
or else that in ascertained cases, such as the importation of lepers in 
modern times to Europe or to America, it was clear that importation 
did not and does not give rise to new areas of endemicity. At all 
events, their reference to the function of natural resistance was by 
way of meeting this difficulty among others. They suggested that 
lepra would be likely to spread or to be maintained by indirect com- 
munication when the disease was introduced, or existed, among a 
people whose natural resistance was reduced by poverty in general — 
by food in some measure inadequate to physiological needs, and by 
the insanitary conditions usually found concomitant therewith. Not- 
withstanding the source of this view, I venture to say that I have not 
yet succeeded in seeing anything more than a platitude in it, no 
suggestion having been made (though an implication there unavoidably 
was) that reduced efficiency of the defensive function stood in any 
special relation to leprosy among all the infective processes. It seems 
to me, therefore, to be a generality. We are but just beginning to 
learn something of the physiology of defence, it is true ; but clinicians 
have always observed that of all the not specially protected persons 
exposed to infection, whatever the disease might be, some resisted it 
and escaped. And clinicians have always seen reason to believe that 
poverty and filth iu some form were predisponents to many of the 
infective processes, and therefore we may suppose it possible that 
they dispose to leprosy too. So that it must be asked what this 
proposed explanation amounts to. Does it exclude the inhabitants of 
any country? Are there at this day no poverty and filth in Norway, 
where lepra began to diminish long before the measures of partial and 
imperfect isolation in force there could have taken effect ? Are there 
none in the great cities of Europe to which lepers return, and where 
tliev live harmlessly as regards their neighbours? And, after all, is 
it not the case that of all the poverty-stricken on recognised leprosy 
areas a very large majority escape the disease — that lepers are fouud, 
at most, iu but verv low proportion to the total poverty-stricken 
population? From the account of leprosy in Madeira, by Dr. Jules 
Goldschmidt,* let me give you a very striking example of this. On 
that island all lepers were never isolated, though about the year 1500 
a lazaret was established to which poor lepers only were forcibly 
removed from all the parishes on the island until 1860 ; and since 
1860 ail lepers have been entirely unrestrained. The people them- 
selves do uot regard lepra as a communicable dise^e ; they ascribe its 
occurrence to the use of a certain vegetable, and in consequence 
regard cases with perfect indifference, and live in cpiile ordinary 
contact with the sufferers. Now, the area of the island is very small 
— about 780 square kilometres— and its population is about 130,000, so 
* “La Ifcpre. Observations et experiences personelles. ” Par le Docteur Jules 
Goldschmidt, Paris, 1891. 
