Page:Tropical Diseases.djvu/691

XXXVI] and public places. All lepers in the ulcerative stage of the disease, when it is to be presumed that myriads of bacilli are being constantly given off from their sores, should be still more scrupulously isolated, their discharges, clothes, and dressings being systematically destroyed or disinfected. A child born of a leper should at once be removed from the diseased parent, and, if necessary, cared for at the public expense.

Leprosy is feebly contagious, or rather, the conditions for successful contagion rarely occur; so rarely, that it is more than probable that under such a modified system of segregation and isolation as that indicated they would occur so seldom that the disease would rapidly die out. Vaccination.— It has riot been actually proved that leprosy can be communicated by vaccination, although there is some evidence in favour of such a supposition. But, although this has not been proved, it is an obvious and very desirable precaution, in countries in which the disease is endemic, to take care that the vaccinifer is not only not the subject of actual leprous eruption, but also that he or she comes from a family and community free from leprosy. An apparently healthy vaccinifer may contain lepra bacilli in a latent state— may be, in fact, a potential leper and capable of communicating the disease.

Treatment.— Scrupulous and systematic attention to personal and domestic hygiene and cleanliness; frequent bathing and the free use of soap; frequent changes of underclothing; good food; fresh air; light work; the avoidance of overstrain, fatigue, and of exposure to bad weather— these things are all of prime importance in the treatment of leprosy, and should be insisted on. It has been found that most lepers on being placed in favourable hygienic conditions improve for a time, and that in a small proportion of cases the disease by these means may sometimes be actually arrested. Europeans who have contracted leprosy in the tropics almost invariably undergo temporary improvement on return to the more bracing climate and more nutritious diet of their native lands. It seems to me that the methods