that in some way it must be communicated from the sick to the well. Indeed, it would otherwise be difficult to conceive as to how the disease is propagated. Certain families manifest a special susceptibility to the disease and its hereditary transmission is claimed. by some authorities; but if we admit this it will not account for the development of the disease in previously healthy adults and in the cases occurring in individuals whose parents had no taint of the disease. Moreover, there are numerous instances of individuals born of leprous parents who have grown to manhood or womanhood without developing the disease. intimate association of husband and wife, also, fails in most instances to give rise to leprosy in the healthy member of the pair, the other being a leper.

The

Notwithstanding the facts stated most recent authorities insist that leprosy is a contagious disease which can be communicated, under conditions not yet well understood, by those infected with the bacillus of the disease to healthy individuals having a special predisposition to such infection. According to Dr. Morrow of New York, who has made a special study of this disease: "The literature of leprosy abounds with well-authenticated cases of individual contagion, showing in the clearest and most positive manner that the disease spreads from leprous to healthy persons by contact." The same author says:

"If the observer limits his field of examination and judgment to certain parts of Europe and the United States, he may find little clinical evidence of the active spread of leprosy by contagion. Observation shows that leprous germs introduced into these favoured regions do not take root and spread; they rarely survive the death of the leper. In New York, for example, large numbers of lepers coming from countries where leprosy is endemic have lived for years, many of them have been sent to general hospitals, where they have died, and yet, so far as is known, no case of indigenous leprosy can be traced to association or contact with these patients. The same experience has been noted in London, Paris, and Berlin, where lepers from other countries have flocked for treatment and have been received in the general hospitals without special measures of isolation, and yet no case of leprous contamination has been traced to contact with them."

The same author calls attention to the fact that one hundred and sixty Norwegian leper immigrants have settled in our Northwestern States, where most of them have eventually died, but no cases have occurred among those associated with them. On the other hand, leprosy has extended in Louisiana, in the Sandwich Islands, and in many other parts of the world, as a result, apparently, of the introduction of cases from other endemic foci of infection.

Morrow believes that the main factors which lead to the propagation of the disease are individual predisposition and insanitary surroundings. Certain authors insist that a fish diet has the effect of establishing a predisposition to the disease. In support of

this theory they call attention to the fact that the disease is more prevalent, in certain countries, along the sea-coast, where fish contributes a considerable proportion of the diet of the inhabitants. The influence of insanitary surroundings and uncleanly habits in promoting the spread of the disease is generally admitted.

The conditions among the peasantry of Norway, where the disease is quite common, are stated by Leloir as follows:

"The Norwegian peasant is very dirty. The greater number of the peasants have never taken a bath. They may sometimes wash (once a week) the hands and face, and the feet once a year, but the other parts of the body are not washed from the day of their birth to that of their death. Their clothing is never taken off even for the purposes of sleeping. It is generally made of wool. Their garments are never washed. Dirt is allowed to accumulate upon them, and when not too rotten, they are often transmitted from generation to generation. They live promiscuously gathered together in a small house.

Dung and filth are accumulated around the house amidst pools of dirty water. Often pigs, poultry, and other domestic animals live with. the family. Almost always several persons sleep in the same bed, which is nothing but a kind of wooden chest upon which are thrown some sheep skins or goat skins which are scarcely ever washed. If a stranger comes he shares the bed. Everybody eats at the same table, from the same dish, often with a common spoon, and drinks from the same vessel."

With reference to the habits of the natives of the Sandwich Islands Mr. Meyer, Superintendent of the leper settlement at Molokai, says:

“Their modes of eating are so extremely careless that inoculation can readily take place through the mouth, by means of the saliva or otherwise. They pass their pipes from mouth to mouth, whether any of their number is a leper or not; they kiss and rub their noses together; they eat out of the same calabash with their fingers and drink out of the same cup; in eating fish or meat it is not cut up, but one takes the meat in his hand, and, after taking a bite, passes it on. They drink ava, which is prepared by others chewing the root, and whether the one chewing is a leper or not is not considered. Foreigners also become addicted to this habit of ava drinking, and it is remarkable that most of the foreigners who have become lepers are ava drinkers."

These habits would evidently favour the communication of the disease in the manner by which Morrow believes this usually occurs, which is shown by the following quotation from his valuable article in the Twentieth Century Practice of Medicine. He says: "In the vast majority of cases, I believe that the vehicles of the virus through which contagion is effected are the secretions of the nose and mouth, and that the port of entrance is the mucous membrane of the respiratory and intestinal tract, with secondary infection through the blood or lymphatic system."

There is little doubt that leprosy has existed from a remote antiquity, although there is some difficulty in identifying the disease as we know it by the descriptions of leprosy given by Hebrew, Greek, and Arabian authors. In the Middle Ages, also, although the disease was far more prevalent than at the present

day, other diseases were, no doubt, frequently confounded with it. The disease appears to have existed in Egypt, in India, and probably in other parts of Asia long before it was introduced to the countries of Europe, where it gained its widest prevalence between the sixth and twelfth centuries of our era. Its decline in Europe has, to a great extent, been progressive since the fifteenth century.

In Great Britain, the disease was prevalent during the twelfth, thirteenth, and fourteenth centuries, and numerous "leper houses" existed. The disease was less common during the following centuries, and became practically extinct during the latter part of the eighteenth century, its final seat having been in the Shetland Islands. In 1742 a public thanksgiving was ordered for the permanent disappearance of leprosy from the Shetland Islands. The last leper of the Shetland Islands, it is stated, died in the Edinburgh Infirmary in 1798 (Morrow). In southern Europe the disease began to decline towards the close of the seventeenth century.

At the present day India and China are the chief centres of leprous infection. The census of India for 1891 gives the total number of lepers in that country as 114,239. The disease also prevails in Cochin China, in the Malay Peninsula, in the Dutch East Indies, in the Philippine Islands, and in Japan. In