27

A.—2

In this connection it is important to note that Dr. R. M. Wilson, of Kwang Ju, Korea, has recently recorded that he has found that Chinese lepers objected to continuing for long ethylester injections, but readily submitted to injections of the whole oil (species not mentioned), which also gave much better results than the esters, his paper including a photo of fifty-nine recovered lepers, while seventy-five were discharged apparently cured in May, 1924, and forty more are nearly ready for release. Cultivation of Hydnocarpus wightiana in Leprosy-infected Countries. I have ascertained from competent botanists that this tree can readily be raised from seed and should grow well in any fairly warm and moist climate, being found over large areas in southern India, and Dr. Hill, Director of Kew Gardens, has kindly promised to distribute the seed through . the colonial Agricultural Departments to all our colonies who wish to cultivate this valuable species, and our association offered last September to supply the seed to those desiring to avail themselves of this offer. When all leper institutions and infected countries grow their own supplies, for the tree fruits abundantly all the year round when five or six years old, the cost of the oil and its ethylesters will be very small, and the full benefits of the recent advances will be generally available to those afflicted with leprosy. The Principles of Present-day Prophylaxis against Leprosy. 1 now turn to the application of the above discussion to the problem of the most suitable prophylaxis against leprosy in different parts of the British Empire, bearing in mind the following essential facts, the proof of which is given in the new book on leprosy by Dr. E. Muir and the writer :— 1. Leprosy is not a highly infectious disease, not, in fact, nearly as much so as tuberculosis (against which no drastic segregation measures would be tolerated for a moment), infection rarely taking place except after close contact, usually by living in the same house with a leper. 2. Nodular cases are twenty times as infectious as nerve ones, through bacillus-containing discharges from ulcers of the skin or nasal lesions ; but in the very early stages Muir found only 27 per cent, of the skin and 4 per cent, of the nerve cases to be in any way infectious, while advanced chronic nerve cases are also rarely infectious, so most of them do not require to be isolated. 3. Children and young adults are most susceptible, 50 per cent, of infections taking place by the age of twenty, and 75 per cent, by thirty, after which susceptibility is slight ; so young people should on no account reside in the same house with an infective leper, and it is most essential to separate from their parents all children of lepers from the time of birth. 4. Conjugal infections only take place in about 5 per cent, of exposures, owing to the most susceptible ages usually being already passed. 5. The average incubation period is between two and three years, and it rarely exceeds five years. 6. Muir has shown that nearly every early case of leprosy clears up under the present treatment within a few months, but in cases of some duration two or three years may be required, and failures are not infrequent. 7. Typical nodular cases die on an average in eight to ten years, and nerve ones usually become uninfective within that time, so that if the great majority of early cases can be treated and cleared up few infective ones will remain after ten years, and the disease would rapidly decline. Effective treatment in the earliest stage of the disease is thus the key to present-day prophylaxts. The Ideal Methods of Leprosy Prophylaxis. 1. Immediate compulsory notification where compulsory segregation is being enforced, followed by clinical and microscopical examination by an expert Medical Board to confirm the diagnosis and ascertain if the case is in an infective stage. 2. Isolation of cases discharging lepra bacilli from skin or nose, with the best possible treatment until free from infection for six months to a year, preferably in a leper hospital or colony, home isolation under the Norwegian system only to be permitted under favourable sanitary conditions and frequent medical inspections, provided no person under fifteen, preferably under twenty, resides in the house. The sexes should be separated as far as possible, and any children of lepers removed from exposure to infection from their parents from birth. 3. All contacts with a newly discovered leper should be examined every six months for three to five years to enable all infections to be discovered and treated in the earliest stage of the disease. 4. In countries taking effective steps to reduce leprosy all immigrants arriving with the disease or developing it within five years of arrival should be repatriated. 5. All early uninfective cases should be treated in hospitals or out-patient clinics or dispensaries, and be only liable to isolation if they do not attend regularly as long as required, which will be for at least six months after all visible signs have cleared up. They should also be prohibited from following occupations connected with the preparation of food or clothing, and from domestic service in houses inhabited by young people. 6. The conditions of isolation and treatment should be as comfortable and as little irksome as possible, as any drastic measures leading to extensive hiding of early cases are likely to do more harm than good. Even under the humane Norway system only one of every six lepers was discovered within three years of the onset of the symptoms in the absence of effective treatment, but now in Hawaii, the Philippines, Basutoland, fr.c., early cases are coming forward and asking for treatment, which has completely revolutionized the position of prophylaxis.

5—A. 2.