Volume 47 · Issue 03 · 1933

The subject for our consideration is difficult of presentation within the limits of a brief paper. We can, at least, review something of the situation as known to us in earlier years and attempt a comparison. With the situation as we see it to-day.

In his paper on the World Situation of Leprosy Mr. Anderson has called attention to the immense problem that is still confronting us, and this is particularly true of China where any organised attack on leprosy has only recently been thought of, and where circumstances of peculiar difficulty have greatly hindered any advance in our knowledge of its distribution.

The topic assigned to me for this discussion is so broad that it necessitates wandering widely over the field of leprosy. There is so much that is not known definitely about this disease that practically any phase of it is a matter for research. One would not go as far as did one person who, in discussing a suggestion that there should be, somewhere, a center for graduate training in leprosy, was inclined to discourage the idea because there is so much that is not definitely known. But it may be agreed that any serious work on the subject may afford new knowledge.

It requires a good deal of optimism and courage to make an attempt to comply with the title of this lecture. In one of my previous papers in relation to the diagnosis of leprosy I stated that the exact diagnosis of leprosy rests on the positive bacteriological finding. I am afraid that this statement cannot hold good to such an extent when we are dealing with the early symptoms. One of the most puzzling features in this disease is the inability to find the specific bacilli, even in such lesions as are on clinical grounds considered to be undoubtedly of leprous origin. That we do not find bacilli in the late trophic manifestations of the disease is perhaps not to be wondered at, but much more important is the question of why one fails to find the specific organism in macules, one of the earliest manifestations of the early stages of the disease. But when we are speaking of macules, we are already transgressing the scope of the present paper, because macules are preceded by symptoms partly subjective, partly objective, which we consider as early manifestations of leprosy.

Since the successful manufacture of the purified ethyl esters of chaulmoogra oil a decade and a half ago and their use in the treatment of leprosy, the interest in leprosy from a medical viewpoint has been revived and in place of an attitude of pessimism the medical profession has entered whole-heartedly in an attempt to conquer the lepra bacilli in their invasion into the human economy.

Over a period of about 6 years 695 cases of leprosy--502 male and 193 female--have been diagnosed at the Swatow Mission Hospital. Many of these have failed to come up for treatment, stopping away altogether after a few injections but over a hundred cases keep up their attendance fairly well.

In the printed programme I am put down to speak on the treatment of leprosy. Unfortunately I have nothing to contribute on those lines which is not already well known to workers in leprosy but think that it may be worth while to go briefly into the circumstances of our leper work in Hangchow, with a few observations as to the apparent geographical and occupational distribution of the disease as we find it among our patients.

The campaign against any contagious disease must be based upon the proper interpretation of ascertained facts regarding the nosology and loimology (epidemiology) of the particuIar disease. The problem of leprosy is so difficult to deal with because experimental medicine has, so far, failed as an auxiliary instrument in solving the perplexities accumulated through the collection of clinical data and facts. The evaluation of dafa is greatly hampered by lack of uniformity in interpretation as no standardization of procedure exists. In the field of leprology, results of significance in any investigation, therefore, cannot but depend on the standards and values being attributed to peculiar factors by the examiner and his individual interpretation.

There have been some changes in our Leper Colony in recent months and.I want all our friends to know about them. First, in the physical equipment; another room has been added to the little hospital making more room for surgical cases and for those actually ill. Then six new houses have been built--four of them are the usual native style thatch roof buildings, each large enough to accommodate eight patients. The other two are the first permanent houses in the colony and will each house ten people comfortably.

For the past six or seven years we have noted among the inmates of our inStitutions at Soonchun and Fusan a condition very similar to pellagra which might be termed PelkWroiet. (Tuberculoid and Such termS are often used in skin diseases). It is known among the lepers as "Red Disease!" Quite like Cazal who, in 1762, called it "mal de la rosa."

Leprosy in China, as in other parts of the world, has been known from times immemorial. Whereas the disease has been almost eradicated from Europe and also from North America, it is still firmly entrenched in many oriental countries like India, Burma, Siam, Malay Peninsula, China, Japan, the Philippines, and also South America, etc. Because leprosy is a chronic as well as an ancient disease, people including medical practitioners possess conservative views and do not seem to realise the marked progress that has been made in its treatment leading often to complete cure, especially in the early stages. So far as China is concerned, numerous health and public organisations still cling to preconceived notions as to its gross infectivity, refusing to have dealings with sufferers and even to allow leper institutions to be established within the precincts of the city. This erroneous idea is no doubt due to the obvious, though superficial, manifestations of the disease which are often of a repulsive nature. But if these misguided people could only look into the inside of a consumptive patient with lungs containing massive cavities lined by brokendown tissue and filled with purulent matter, they would feel more nervous about the latter than about the external nodules of the leprous individual.

The event of the year for those interested in leprosy work in China was the calling of the first National Conference ever held on leprosy in this country.

In the pressure of health problems which the Government has had to meet the problem of leprosy has unfortunately been pushed aside. Naturally those of us who are keenly interested in the disease in this country have been correspondingly disappointed. There are good prospects, however, that the question may be tackled before very long, and amemorandum has been prepared by a medical committee appointed by the Conference for presentation to the Board of the Chinese Mission to Lepers.

In defiance of every cannon of leprosy and the inspired word of our leprologists, the writer of this editorial ventures to offer his heartiest congratulations to Dr. Galt on his unique venture. The truth, as we see it, is that most of us are unwilling to face the facts and draw the logical inferences therefrom.

We wish to keep before our readers the claims of the International Leprosy Association, and of its offical organ, The INTERNATIONAL JOURNAL OF lEPROSY.