Page:Tropical Diseases.djvu/690

644 Articles of diet, such as imperfectly cured fish, have been incriminated as media for infection. Sir Jonathan Hutchinson for many years strenuously advocated this doctrine. The historical, epidemiological, and circumstantial evidence on which it is sought to establish this speculation, though highly suggestive, is, in the opinion of most authorities, insufficient.

Prevention.— If it be conceded that leprosy is caused by a germ, that it is contagious directly or indirectly, and that it never breaks fresh ground unless first introduced from without and by a leper, then the leper must be regarded as a source of danger, and, qua leprosy, the only source of danger to any community he "may live amongst. Therefore a sure and the most effectual way of suppressing the disease is the thorough isolation of existing lepers. There are many difficulties, however, especially in such countries as India, in giving practical expression to what appears to be a perfectly logical conclusion difficulties springing from the rights of the individual, finance difficulties, difficulties arising from concealment or incorrect diagnosis, as well as from the continued introduction of fresh cases from without. These and other obvious obstacles, incident to any attempt at a wholesale system of thorough isolation, are so great that the most that can be hoped for at the present time, and in the present state of public opinion, is some modified system of segregation and isolation, such as has worked so successfully in recent years in Norway. Where possible, therefore, lepers should be segregated in isolated asylums, which should be so conducted as to prove attractive. Those who cannot be made, or persuaded, to enter these asylums should be isolated as much as possible from their families and the public; scrupulous cleanliness of their persons and houses should also be insisted on. Lepers ought not to be allowed to beg in the streets as is often the case in Eastern cities to keep shops, or to handle food or clothes intended for sale, to wander about the country as pedlars or mendicants, to hire themselves out as servants or prostitutes, or to frequent fairs