impossible—the mode of contamination being as yet unascertained, as well as the period of incubation of the germ—still there are unimpeachable practical proofs of contagion, such as the effect of isolation on the spread of the disease, and cases of healthy persons contracting the disease when exposed (Fathers Damien and Boglioli, nurses, and attendants), even accidentally, as in the instance of a medical student who cut himself while making a post-mortem on a leper. In the international conference at Bergen, these evidences were deemed convincing enough to call for a declaration that the disease be considered contagious.
The period of incubation is "estimated at from a few weeks to twenty and even forty years" (Dyer). Like most infections, leprosy has a preliminary stage, uncertain in its character: there are loss of appetite, dyspepsia, and nausea, neuralgia, rheumatic and articular pains, fever, intermittent or irregular, unaccountable lassitude and anxiety. Those premonitory symptoms, which may last for months, arc followed by periodical eruptions. Blotches, first reddish, then brown with a white border, appear and disappear in various parts of the body; sooner or later small tumours, filled with a yellowish substance fast turning to a darker hue, rise sometimes on the joints, but oftener on the articulations of the fingers and toes. These tumours, however, are not yet specifically leprous; at the end they may leave permanent spots, pale or brown, or nodules. Then the disease, manifested by the apparition of specifically leprous formations, diverges into different varieties, according as it affects the skin and mucous membranes (cutaneous leprosy), or the nerves (anæsthetic), or both (mixed, or complete); each of these varieties, however, merges frequently into the others, and it is sometimes difficult to draw the line between cases.
Cutaneous leprosy is either macular or tubercular. The former variety is characterized by dark (L. maculosa nigra), or whitish (L. m. alba) spots, usually forming on the place of the old blotches; the eruption, at first only intermittent, turns finally into an obstinate ulcer with constant destruction of tissue; the ulceration usually begins at the joints of the fingers and toes, which drop off joint by joint, leaving a well-healed stump (L. mutilans); it is sometimes preceded by, and ordinarily attended with, anæsthesia, which, starting at the extremities, extends up the limbs, rendering them insensible to heat and cold, pain, and even touch. In the tubercular type, nodosities of leprous tissue, which may reach the size of a walnut, are formed out of the blotches. They may occur on any part of the body, but usually affect the face (forehead, eyelids, nose, lips, chin, cheeks, and ears), thickening all the features and giving them a leonine appearance (leontiasis, satyriasis). Tubercular leprosy develops rapidly, and, when attacking the extremities, its destructive process has the same effect of ulceration, mutilation, and deformity as has been mentioned above. Scarcely different from the preceding in the period of invasion is the course of anæsthetic leprosy, one of the characteristic symptoms of which is the anæsthesia of the little finger, which may occur even before any lesions appear. The ulcer, at first usually localized on one finger, attacks one by one the other fingers, then the other hand; in some cases the feet are affected at the same time, in others their ulceration follows that of the hands. Neuralgic pains accompany the invasion, and a thickening of certain nerves may be observed; motor-paralysis gradually invades the face, the hands, and the feet. Consequent upon this, the muscles of the face become contracted and distorted by atrophy; ectropion of the lower lids prevents the patient from shutting his eyes; the lips become flabby, and the lower one drops. The sense of touch and muscle-control being lost, the hands are unable to grasp, and the contraction affecting the muscles of the forearm produces the claw-hand. In the lower extremities analogous effects are produced, resulting first in a shuffling gait and finally in complete incapacity of motion. Then the skin shrinks, the hair, teeth, and nails fall, and the lopping-off process of necrosis may extend to the loss of the entire hand or foot. The mixed variety of leprosy is the combination and complete development of the two types just described. In all cases a peculiar offensive smell, recalling that of the dissecting-room mixed with the odour of goose feathers—the authors of the Middle Ages compared it to that of the male-goat—is emitted by the leper, and renders him an object of repulsion to all who come near him. Add the torture of an unquenchable thirst in the last stages of the disease, and, as the patient usually preserves his mind unaffected to the end, the utter prostration resulting from his complete helplessness and the sight of the slow and unrelenting process of decomposition of his body, and it is easy to understand how truly, in the Book of Job (xviii, 13), leprosy is called "the firstborn of death".
The average course of leprosy is about eight years, the mixed type being more rapidly concluded. "Death is the ordinary conclusion of every case, which may come (in 38 per cent of cases) from the exhaustive effects of the disease, from an almost necessary septicæmia, or from some intercurrent disease, as nephritis (in 22.5 per cent); from pulmonary diseases including phthisis (in 17 per cent), diarrhœa (in 10 per cent), anæmia (in 5 per cent), remittent fever (in 5 per cent), peritonitis (in 2.5 per cent)" (Dyer).
So far leprosy has baffled all the efforts of medical science: almost every conceivable method of treatment has been attempted, yet with no appreciable success. Occasionally the treatment has been followed by such long periods of remission of the disease (fifteen or twenty years) as might lead one to believe the cure altogether complete; still, specialists continue to hold that in such instances the virulence of the bacillus is, through causes unknown, merely suspended, and may break forth again. It being admitted that the disease is both contagious and preventible, there seems to he no doubt that means of public protection should be provided. To answer this purpose, several countries (Norway and Sweden in particular) have by legislation ordered the isolation of lepers. In some other countries the Governments encourage, and, more or less generously, subsidize private establishments. Of all the states of the Union, Louisiana is the only one to have taken any definite steps: it partly supports the leper-home at Carville where some seventy patients are housed under the care of the Sisters of Charity of St. Vincent de Paul (Emmitsburg). Some, not unwisely, think that if the federal authorities do not deem it right to interfere, individual states, especially those which, like California, are exposed to a constant danger of infection, should take means of preventing the spread of the disease.
III. Leprosy in the Bible.—The foregoing sketch of the pathology of leprosy may serve to illustrate some of the many passages of the Bible where the disease is mentioned. From the epoch of the sojourn of the people of God in the desert down to the times of Christ, leprosy seems to have been prevalent in Palestine: not only was it in some particular cases (Num., xii, 10; IV Kings, v, 27; Is., liii, 4) looked upon as a Divine punishment, but at all times the Hebrews believed it to be contagious and hereditary (II Kings, iii, 29); hence it was considered as a cause of defilement, and involved exclusion from the community. From this idea proceeded the minute regulations of Lev., xiii, xiv, concerning the diagnosis of the disease and the restoration to social and religious life of those who were cleansed. All decisions in this matter pertained to the priest, before whom should appear personally both those who were suspected of leprosy and those who claimed to be healed. If, at the first examination, the signs—coloured nodule, blister, shining
