?3
formerly as these two ratios would imply, it fol-
lows that in earlier years there were more lepers
living than are entered in column 10: those
entered in the amended column 9, with a nearly
uniform death-rate throughout of 9 per cent.,
giving manifestly the correcter estimate. Sup-
posing, therefore, leprosy to be in Norway the
same scourage now as ever, on this basis I reckon
there may have taken place a diminution of
about 30 per cent. in the total number of its
victims.
The above data, in general, concur; and there
being none to my knowledge adverse, the point
in question must be regarded as affirmed.
B.-Movements amongst the Leper Community:
Columns 4, 5 and 6.
Columns 4, Mortality.-For the whole 25 years
the mean annual deaths are 202; of late about
160 only, of which 87 in Asylums and 73 in the
districts. Formerly, when the afflicted were
more numerous, the deaths also were commoner
and rather most frequent in the districts. The
mean death-rate of leprosy in Norway is 8-9
per cent. per annum: amongst the incarcerated
(who include the worst and most advanced cases)
the mean death-rate rises to 9-14 per cent. per
annum, whilst among home-dwelling sick it
may be estimated at 5-7 per cent. per annum.
For many years past there has not occurred any
marked or progressive change in the mean death-
rates; thus, in 1862 that of Asylums was 13 per
cent. and of districts under 6 per cent., whilst in
1880 the former was 11·3 per cent. and the latter
also under 6 per cent. The greater range among
Asylum-inmates than outside these institutions
is owing, as appears, to occasional brief outbreaks
of local sickness (see below).
Column 5.-In the mean about 10 subjects
yearly leave the Asylums uncured, or outside
become lost sight of; equal to about 1/2 per cent.
of the totals known. In Norway, as elsewhere,
lepers are subject to home-yearning, secretiveness
and impatience of control; but there are fewer
facilities for evasion or decamping here, than
would be in India.
Column 6, The Healed.-The Norwegian
authorities have always candidly recognized and
published a paucity of results under this heading,
which of itself betokens the present hopelessness
of a cure for Leprosy, and the need of sole
reliance on preventive measures, for mitigation
of this scourge. In the table are entered only
107 as healed, the total annual mean being 4 or
5 cases reported from both Districts and Asylums;
equal to 1.63 per cent. of grand total of lepers
6,918, or yearly less than 1/4 per cent. Neverthe-
less, the systematic use of drugs is practised in
the Asylums, and particularly in Lungegaard
Hospital under charge of the venerable Dr.
Danielssen, where are admitted cases specially
adapted for early and energetic treatment. It
appears from the Reports that most recommend-
ed remedies have been fairly tried, yet without
any uniformly successful result; and some partial
mitigation of suffering is as yet all that drugs can
effect. I also note that the detailed tables have
a column for cases relapsing into sickness after
'healing'; and from observation everywhere,
it is known that the more prominent marks of
disease may spontaneously subside, more or less,
and remain in a quàsi latent state for several
months, or years. In confirmed cases, some evi-
dence of the infection may at all times be detect-
ed; so that 'cure' becomes a provisional expres-
sion. And, lastly, I see in these European docu-
ments a reflex of Indian experience; in the occa-
sional disappearance of skin-disease termed le-
prous, but really of a different and more amen-
able character.
C.-The Isolated and Non-isolated: Columns
7 and 8.
Column 7, Home-dwellers.-Necessarily, from
their large numbers, all lepers in the country
could not be relegated to Asylums; but the aim
has been to isolate as many as practicable under
existing conditions. The result is, according to
the table, that the series of district-residents is
a steadily diminishing one, now amounting to
only 37 per cent. of its earliest sum. At suc-
cessive decennial periods the numbers in column
7 were as follows:-1860, at home 2,242 or
about 80 per cent. of total lepers then known;
in 1870, at home 1,769 equal to about 70 per
cent.; and in 1880, at their homes 965 or about
61 per cent. of all afflicted then known. By the
year 1885 it is anticipated that 50 per cent., or
one-half the entire leper-community, will be
isolated; and by 1895 it is hoped that 75 per
cent. may be so separated, leaving only 25 per
cent. at unrestricted liberty amongst healthy
persons. That there really has taken place this
most desirable diminution in the number of free
home-dwelling sick is shown inferentially by the
lessened proportion of deaths therein occurring;
thus, whilst during 1860-70 the numbers dying
both within and without Asylums were nearly
identical, during 1870-80 the proportion of
Asylum-deaths rose to 71·6 per cent. and that of
district-deaths sank to 28·4 per cent. of total
deaths. In fact, the declining loss of life from
leprosy in Norway is due solely to lessening of
home-mortality; and the smaller this becomes,
obviously the better for the common weal.
Column 8, The Immured.-In a population of
any size the amount of Asylum-accommodation
must be so limited, that only a part of all lepers
can be segregated from the sound. In Norway,
three large and two smaller institutions-of which
three at Bergen and two further north-com-
prise the available means of isolation; capacity
equal to lodgment of 800 sick: total population
of country about 2,00,000, total lepers still near
2,000. The minimum of incarcerated was 235
in 1856, the maximum 759 ten years later; and
thence a slow decline to 617 in 1880. This de-
cline is not due to lessening of accommodation,
but to persistent unwillingness of the peasantry
to send in their sick; and I learn it is now con-
templated to seek more compulsory legal powers
of segregating lepers, if not in the Asylums then
at their own homes. That a real and continuous
progress of isolation has, however, already been
effected is evident:-thus, at first in 1856, only
about 8 per cent. of sick were immured; in 1860,
the figures were 539 in 2,781, or 19 per cent.;
and in 1870 they had risen to 764 in 2,533, equal
to 30 per cent. In 1880 the figures were 617 in
1582, or 39 per cent.; but this datum is an uncor-
rected one, and it may be that the ratio of im-
mured to free has not of late much increased.
If this surmise be as correct as it seems there
is, I would remark, additional reason to urge
isolation at home in aid of the more public
means. The numbers yearly admitted into the
Asylums during the past 20 years has varied
from 173 to 112: during the last quinquennium