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From this time leprosy rapidly extended over continental Europe, becoming the terror of all countries, owing to its incurableness, helplessness and disgusting appearance.
Special establishments, called leper houses were erected for them. Such houses existed in France in the 7th century and in Germany and in Italy also, at the time of the crusades the disease became the most prevalent.
In France alone in the time of Louis the 8th there were 2,000 lepers and not less than 9,000 elsewhere. The order of St. Lazarus whose head master was a leper, was founded for their benefit.
Investigations and researches regarding lepra began in the rith century and the peculiarities which marked the medicine of that day left their impression upon the work. The western world was indebted or indirectly to the Arabians for the knowledge of leprosy possessed by the Greeks.
Constantinus Africanus, a teacher in the school of Salerno,estab lished the doctrine which prevailed and was the medical guide till the middle of the 14th century. Lepra was divided into 4 varieties, and other names and varieties
4 were used until confusion became so universal that other skin diseases were confounded with it, and the difficulty of unraveling the complicated condition became impossible. At this time, toward the end of the 16th century the disease began to disappear from Europe and syphilis made its appearance. This was a new and ravaging scourge and much discussion prevailed regarding its etiology, many claiming it was an offspring of leprosy, and this view is still held by not a few.
About 100 years ago Hensler made the first attempt toward clearing up the etiological difficulties regarding lepra that had been made for two centuries, studying the entire literature from the Greeks down. Danielson and Boeck give the first clear account, however, making extensive travels and study; their works, comprising 3 volumes, appeared respectively in 1842, 1848, and in 1862. Hebra, another observer in 1852, and Virchow in 1850, made extensive studies largely pathological, after which numerous publications appeared by various authors and scientists from all parts of the world, and yet there are many points not settled.
Aitkin defines leprosy as a constitutional hereditary non-contagnous affection, expressing itself by shining tubercles. red or livid on
the face, ears and extremities; the face is wrinkled, rough and unctuous, there are disorders of innervation, with ulceration and death of the affected part.
Prof. Neisser, of Breslau, our best authority, describes leprosy as a parasitic disease of chronic course and considers it contagious and its histology settled. Observers in this country agree with him except as regards its histology.
The alleged discovery of a bacterium in leprosy has thrown much light on the study of its morbid condition, its etiology before being very obscure, and such common causes as diet, climatic influences, bad hygiene, etc., etc., proved to be unimportant factors, as we find the disease in different countries where the most opposite conditions prevail, that the most popular and most probable factor in its propagation is hereditary influence, that direct contagion is considered to be the most common cause of its growth in countries where it has been carried by immigration. Regarding hereditary
. influences we find differences of opinion according to the localities where found. The late Prof. Wm. Boeck, of Norway, well known in medical literature, through his contributions on leprosy and syphilis, visited in 1870 the lepra-infected section of Minnesota to study what influence the change of climate, diet, etc., etc., had had on the development of the disease.
One case which had left Norway a leper had recovered. Two which had developed there in Minnesota had also recovered, this previous to his visit. Prof. Boeck found 18 cases in Iowa, Wisconsin and Minnesota. They all were natives of Norway where the disease is endemic. Prof. Boeck considered them all caused by hereditary influences, in a direct or lateral line.
But one of the 18 had no leprous relation and consequently his case he thought might be due to contagion. Prof. Boeck is of the opinion that the lepers are better off here than they would have been had they remained in the old country. To quote Prof. Boeck's words, “they have come away from the places where we see leprosy may originate spontaneously and which will certainly favor its development, where the disposition is thereby hereditary. They have settled on fertile lands where they certainly have to work hard, but they never undergo hardship as we in Norway understand the term. Here in America there is no work that can be compared to the mid-winter fisheries off the Finmark coast in an open sea, or the hardships suffered while tending cattle on the high mountain plateaus, which causes so often bring out the latent leprosy.
The investigations and studies of leprosy in Minnesota have been continued by the State Board of Health and in a letter from the Secretary Dr. Hewitt, of Red Wing, 3 years ago I found the Dr.
I had arrived at about the following conclusion, viz: “Had seen no evidences of hereditary among the lepers in his state, the children being free from taint, so that under present conditions he thinks the hereditary power weak and its contagiousness about the same. Late last month I addressed a second letter to Dr. H., asking his present views on the subject. My inquiries were referred to Dr. C. H. Gronvold of the State Board of Health of Minnesota from whom I have the following replies:
“1. The cases reported have been Norwegian with a few Swedes froin adjoining Swedish provinces.
“2. I cannot say whether the disease was dependent on heredity or contagion; there is good authority for both suppositions. The cases reported have been proved either to belong to families in which there have been lepers, or to have come from districts in which lepers have been found.
"3. Several are married and have children, grand-children and great-grand-children, and
“4. In none of the descendants has the disease been observed.
“5. I consider the disease contagious under certain circumstances. The condition of things on the Sandwich Island does not seem to admit any other explanation, but the condition here in the northwest of soil, climate and other things, does not seem to favor the development of its contagiousness—at least no case has so far been traced to contagion as its probable source ;. e. of the cases developed here in America.
“6. The diagnosis admitted of no doubt, therefore no microscopic examination was made."
The majority of late observers who have seen the disease at its worst believe it to be both hereditary and contagious. Regarding the disease in Wisconsin, it being but slightly known, it is now impossible to come to any conclusions under this head; so far as I am able to learn, there have been but four cases of the diseases within our borders.
The first case I have any knowledge of came under the eye of Dr. S. C. Johnson, of Hudson, some 15 years ago in the town of Rush River, St. Croix county, and was of the usual mixed variety. The patient whose residence was at a considerable distance from the doctor, died soon after and I am unable, from the loss of notes on the case, to report particulars. Case two occurred in my own practice in 1878.
E. G, a native of Norway, married 20 years, no children, resided in the town of pleasant valley, St. Croix county, immigrated to America when a young man.
The disease was of the tubercular type and presented a most disgusting appearance. The patient had constipated bowels, dyspepsia and dysuria. He was nearly dead of exhaustion but rallied and lived some six or eight months. He died some time early in the summer of 1879. I was unable to learn anything of value in the family history of this man. He had, however, known of the disease in Norway.
Up to this time I was not aware there were any cases of leprosy in the Northwest, I neither saw or heard of any others till June of 1885, when I was informed by the poor commissioner that there was a pauper in the town of Eau Galle, whom he thought had leprosy. I advised him to report the case which he did, and Dr. Johnson, of the State Board of Health, and Dr. Farnsworth, of Baldwin, visited him and pronounced it leprosy. I had intended to be present with them but was detained.
I subsequently visited the patient and photographed him together with another living but a short distance from the first, and the identity of whose disease was discovered about the same lime. These two cases comprise all of this disease I am able to learn of in the state.
It is possible, nay, probable, that there are others unknown to not only myself, but to other medical men. Attached to the photographs, which I have the pleasure of showing you, is a description of the cases covering the most important points in their history and condition.
Neither of these is married, one is a male the other a female, nor could I learn if any relative in the direct or lateral line had ever shown any evidence of the disease. Neither are the patients akin. Therefore the evidence of heredity is obscure and as for contagion time alone will show.
The tremendous spread of lepra in the Sandwich Islands is
marvelous. From two Chinese immigrants, lepers, there were in 25 years, 4,500 cases of genuine leprosy among the native and European population. The Isle of Trinidad also shows a similar growth though not so rapid. In 1805 there were but eight leprous patients on the island and in 1878 there were 860.
It is evident therefore, from its introduction on these islands, notably in the former, that there must have been other methods of growth than mere heredity, as the following figures show: On Trinidad there were in 1805:
1805 among 29,940 inhabitants 3 patients.
860 The most instructive example however, is presented by the Sandwich Islands. On these islands, distinguished by the healthfulness of their climate, the excellent fertility of the soil, the fine and vigorous development of the natives, the disease had occurred until 1858 only in isolated cases carried thither by landing sailors. Among the natives it was entirely unknown. In 1859 Dr. Hillebrand, a German physician, observed the first two cases of leprosy on the islands, on two immigrated Chinese who came under treatment at the hospital in Honolulu. Since then the disease has increased rapidly to such an extent that the government, as early as 1866, were forced to resort to measures of isolation, and forwarded 400 patients to a smaller adjoining island, Molokai. In 1881, the number of patients in Molokai was 800. The last statistics of the Board of Health estimate that about 4,500 natives, or one-tenth of all the aborigines are affected with leprosy. The native population amounts to about 45,000. From the publications of this Board of Health we learn also that in the last fifteen years, about 2,000 lepers have died in Molokai. All those familiar with these islands are agreed that the morals of the natives especially favor the spread of an infectious disease, while their physical development and the excellence of the climate must appear absolutely inadequate to explain the cause. Stress is laid on the dwelling of large families in small huts,—the common use of the same vessels and utensils, eating from a single dish, the fingers being employed in taking out the eatables, drinking out of the same vessel, smoking the same pipe, the very loose morals, the absence of any dread of the disease, whence pa