FIVE MILLION LEPERS
By DR. ERNEST MUIR
MANY people are surprised when they hear that leprosy still exists in the world. They think of it as something remote in time and distance connected with Naaman and Job and other Bible stories. They are still more astonished when they are told that there are some five million lepers in the world, two million of whom are our fellow subjects in the British Empire, some in England itself. As the elevation above sea level determines the kind of plants that are found in any area, so the level of nutrition and sanitation deter- mines the places where leprosy is found. In this respect it resembles tuberculosis, only it belongs to a less advanced stage of sanitary and social progress. Tuberculosis is a disease of congested towns and industrial centres; leprosy is found chiefly in insanitary villages.
In England we have advanced sanitarily and socially be- yond the leprosy level. Sometimes, though seldom, our countrymen acquire the disease in foreign lands and bring it with them to England. But, though the Ministry of Health has never imposed compulsory notification and other precautions, the infection does not spread, and, with two or three exceptions, leprosy is not known to have been acquired in England in modern times.
People often ask: is leprosy increasing or diminishing? Both are true; according to circumstances it is increasing in some places and diminishing in others. Influenza spreads rapidly through the community and from country to country; it is easily caught, develops quickly, and thus spreads quickly and dies out again. But leprosy, unlike influenza, requires close and often prolonged contact before it can be acquired.
It therefore in ordinary circumstances develops slowly, often requiring years; and it lingers long, it may be for generations, in a single family or small community. But extraordinary circumstances, such as the rapid introduction of good roads, motor 'buses and trains, have led to much more extensive and intimate mixing; far more people are submitted to infection, and hence the disease is widespread and increases. This is one of the dangers connected with the initial intro- duction of western civilisation: improved communications are. easily introduced, but education and sanitation, the antidotes to the consequent dangers, lag far behind.
Children are much more susceptible than adults to leprous infection (the same is well known to be the case in tuber- culosis). Those infected in early life tend to develop a more serious and infectious form of the disease than those who acquire it as adults. Thus it is the childhood infections that are responsible for the perpetuation of leprosy. If every child from birth up to ten years of age could be effec- tively isolated from infection, the disease would soon die out.
Where is leprosy found? In China there are said to be perhaps a million and half, in India one million, in Africa a million, in South America over half a million. These figures are only approximate, but it is calculated that there must be some five million lepers in the world.
What is being done to relieve and control leprosy? Ii`ze problem has been approached from two different angles, which may be termed the " humanitarian " and the " sani- tarian "; each of these is complementary to the other. The humanitarian effort has always been first in the field, and has been carried on almost exclusively by religious bodies. In modern times this side of the work has called forth the devoted and self-sacrificing efforts of missionary societies, chief among which may be mentioned the Mission to Lepers.
In recent years, and especially since the Great War, much concentrated laboratory research and field investigation have been carried out with a view to understanding and controlling leprosy. This has been done by official bodies in various countries where leprosy is common, and especially by the British Empire Leprosy Relief Association in the British Empire, the American Leprosy Foundation in the United States, and by similar bodies in France, the Nether- lands, Japan, China, Brazil and other countries.
In proportion to the labour expended the results have often been disappointing. The germ of the disease is difficult to grow outside the human body, and therefore difficult to study. Some important facts have, however, been learnt, for example : that leprosy is far more common than was at first supposed; that some people are much more susceptible than others; that children and those who are weakened by malnutrition and other diseases are parti- cularly susceptible; that, as in tuberculosis, the milder forms of the disease sometimes heal up spontaneously; that with carefully conducted and prolonged treatment many other cases will recover.
While, as in tuberculosis, the chief treatment consists in improving the general health, the most useful form of special treatment is chaulmoogra oil and its preparations, which. are given by injection into or under the skin or into the muscles. But we still lack what may be termed a " specific "; we have no remedy comparable to quinine in malaria.
In many countries a combination of humanitarian and sanitarian methods is being more and more adopted. In the centre of a district a settlement is established, where chiefly hopeful cases are admitted. These are employed under European supervision in agriculture and useful industries, which provide healthy physical and mental exercise. Others are trained in anti-leprosy work—treat- ment, sanitation, &c. Not only does the well-run leper settlement care for the leper and provide treatment, but it acts as a model of sanitation and industry in the district, and from it as a centre the villages are visited and surveyed, and the people are instructed in the precautions necessary to prevent the spread of infection. Such institutions are generally staffed by missions and subsidised by local govern- ments; and it is agreed by all that this is the best division of labour and responsibility.
Take, for instance, the large settlement in Itu (Nigeria) with its two thousand inhabitants. Here the patients live a life of happy activity and usefulnesi. Palm oil cultivation and manufacture, agriculture, carpentry, building, &c., help to make the institution partly self-supporting, and keep the lepers mentally and physically fit. Children are taught at school and later trained as nurses, dispensers and health workers. Except for a European doctor and his wife, an industrial organiser and his wife, and a Toe H health worker, all the staff is supplied by the lepers themselves. Such an institution, apart from the direct benefit to those within its bounds, is also a source of education and enlighten- ment to the whole district.
The British Empire Leprosy Relief Association, working in conjunction with Toe H, has within the last few years sent out some twenty young men to work in these leper settlements, and volunteers are not lacking who are willing to go out, like Father Damien, and devote themselves to this self-sacrificing work..
So far only the fringe of the problem has been touched. But the British Public are gradually beginning to understand and acknowledge responsibility towards these backward fellow-subjects of theirs throughout the Empire.
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