Leprosy.

LEPROSY.

Since the Third Biennial report in 1885, two cases of leprosy have been discovered in this State, a report of which has been withheld until their final determination was reached.

The first case was reported by Dr. J. I. Bailey, health officer at West Liberty, in March, 1888. Dr. Shrader, of the State Board, gives the following report of his visit to the affected person, accompanied by Dr. E. H. King:

"In Springdale township, Cedar county, Theoline Roseland, aged twenty-four, single, a native of Stavanger, Norway, a blonde, fairly well nourished, who had at that time been in the United States five months, one month traveling about, three months at Montour, east of Marshalltown, Iowa, and one month at West Liberty. According to her statement, about ten years ago a spot, somewhat reddish in character, made its appearance on the outside of small toe of right foot, which continued to spread slowly until it involved the leg to the knee, and has extended up the thigh to the junction of the upper and middle third; it is of the tubercular variety the limb is very much swollen. There are some portions of the foot, leg and thigh that are not covered by the tubercular growths, and in those places not affected, the skin has nearly a normal appearance. Some small spiculæ of bone have been exfolioted from the bones of the foot. Finding she had a brother in Chicago, I directed her to be sent there, and a letter be sent to the proper authorities informing them of the facts. Since then I am informed that her brother has refused to receive her, and she is still in West Liberty, Iowa."

The latter part of March she removed to Marshall county, near Le Grand, and August 8th, Dr. J. I. Bailey, of West Branch, reported that she was doing ordinary house work, much improved in health, and the tubercles disappearing under the influence of good hygienic surroundings, out of door exercise, rest of mind, and soothing applications to the affected limb.

Leprosy.

In June, 1888, another case was reported, near LeGrand, Marshall county, by Dr. C. Reiterman, Health Officer, to-wit:

"Helena Halverson, nee Peterson, wife of Andrew Halverson, Octo29, born at Korpe, near Stavanger, Norway. Parents living and well. Four brothers and two sisters living and well. One sister died in childhood, cause of death not known. Grand parents said to be healthy and long-lived. No history whatever of the disease in the family for several generations back, and no history of exposure to contagion. Came to Iowa from Norway in June, 1886; married in April, 1886; has never borne children. First complained of illness September 1, 1886. A Norwegian lady, however, says she elicited from the patient herself, by adroit questioning, a confession that her health was not good for two or three years before leaving Norway. She has complained bitterly of pains of an erratic character in chest, shoulders and arms, and has been very nervous or "hysterical" much of the time for a year past. Her face wore an anxious look, and she assured her friends that she would die. Bowels constipated, pulse and temperature usually about normal. Nature of case very obscure until about June, when an ulcer

about the size and shape of a silver quarter was noticed at an inferior angle of the scapula, clearly circumscribed, deep, with bright red margin, and dry whitish crust on its floor. A small red, tawny spot, a little lower on the right side, was discovered at that time. A week or two later the ulcer was larger, and covered by a dry, brown crust. Seen Monday, June 9th, with Dr. Clark, of Grinnell. Appearance at that time as follows: Ulcer at angle of left scapula two and one-half inches or more in vertical, and one and one-half inches in transverse diameter. Floor covered with brown slough, margin red, not sensitive or painful. Discharge, which had been quite scanty before, was now considerable. A couple of inches below right scapula was noticed a spot one inch in diameter, rough, scaly, whitish and anæsthetic. Over the left sterno-mastoid muscle, about two inches below the ear, is a small, red, shiny spot, about the size of a split pea, hard and smooth. Said to have a sore of some kind upon buttock, which we could not examine. Pulse, 110; temperature, 100° Fahrenheit. Sensitive to touch or motion. Emaciated, sits propped up in bed all the time. Disagreeable, 'musty' odor is plainly noticeable upon entering the

room."

Leprosy.

August 1st Dr. Reiterman sent the following supplementary report of the case:

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'The further history of the case of leprosy reported July 10th, is briefly told. Diarrhoea supervened a few days after, and persisted about ten days. Strength and appetite failed steadily, while pain and wakefulness increased. The local manifestations progressed quite rapidly, but were not very carefully observed of late. The odor became extremely offensive, and what might be characterized as 'suffocating.' Death closed the scene at 12:30 P. M., August 1st.' Upon the receipt of this report with a view of ascertaining to what extent the disease existed in Norway; what steps were taken to prevent those afflicted with leprosy from emigrating; and so far as possible to inaugurate measures that would in the future prevent their importation to Iowa, the following letter was written:

OFFICE OF THE IOWA STATE BOARD OF HEALTH,

DES MOINES, Iowa, July 14, 1888.

Gerhard Gade, United States Consul, Christiana, Norway: During the last two months two cases of leprosy have been discovered in this State, both subjects being recently women from Stavanger, Norway-one Theoline Roseland, aged twenty-four; the other married, Helena Halverson, nee Peterson. You may readily understand that our people are quite alarmed over this importation of this dread disease into our State, and the rapid recurrence of the cases tends strongly to the conviction that there is a method in the matter. The local authorities must know that these persons are from leprous families. They have no right in comity or justice, to allow them to come here to burden the people with expense, and spread the disease, and our State authorities will take the necessary steps to prohibit their importation into this State, and will send them out of the State if they come. In behalf of the State Board of Health, I desire you to make inquiry regarding this matter, ascertain what regulations are in force there regarding leper families, and take such steps as you can to protect us from this criminal and outrageous importation. Stavanger seems to be a specially infected district. The persistent effort to secret this disease in these two cases is positive evidence of knowledge of it previous to coming here. Please inform this office of the result of your investigations. Yours very truly. J. F. KENNEDY, Secretary.

The following is the reply:

CONSULATE OF THE UNITED STATES OF AMERICA, CHRISTIANA, NORWAY, Aug. 15, 1888.-Mr. J. F. Kennedy, M. D., Secretary Iowa State Board of Health, Des Moines, Iowa, United States of America,-DEAR SIR: I am in receipt of your favor of July 14, relating to the importation into your State

Leprosy.

of two cases of leprosy from Norway, and understand your indignation at such introduction of a most dangerous disease.

In my consular district, which only embraces the southern and eastern Norway, hardly any cases of leprosy are to be found, while about one thousand three hundred persons, who at the present moment are known to be affected with leprosy in this country, are scattered all over the western and northern districts. It is a fact, fully established by the annual statistics, published by the Government's Board of Health, that the number of lepers is constantly and rapidly decreasing. While in 1860 the lepers who lived outside the asylums numbered two thousand two hundred and twenty three, only six hundred thirty-three were to be found at the end of 1885. In the latter year fifteen new cases had been discovered, sixty-three had died, sixty-five had been removed to the asylum, fifteen had left their former districts (in some cases perhaps also the country), and seven were cured. At the end of 1885, five hundred and twenty-four, two hundred and fifty-five of whom were men, two hundred and sixty-nine women, remained at the five asylums established for the treatment of lepers; seventy had died during the course of the year. On the whole it is believed that leprosy will gradually disappear from the country, or at least be confined to some few districts on the coast, where the people are poor, and occupied with fishing in a hard climate.

Relating to the two cases of leprosy recently imported from the district of Stavanger into your State, I venture to say that the local authorities of the district were entirely ignorant of their going to America, and that at least no purpose of getting rid of the unhappy sufferers did exist here. Everybody is allowed, without any restriction, to emigrate from Norway, and the two women in question, who probably have relations in Iowa, had only to go to Stavanger and Bergen, and buy their tickets for passage without communicating beforehand with any of the local authorities. A very superficial medical examination of emigrants is ordered at the shipping ports, but the examiners would hardly have any time for discovering those affected by leprosy without being previously informed of their disease, and of their intention to conceal it.

It certainly would be of great interest to know the parish whence the two women hailed. It might then be ascertained through the pastor of the locality, who would know themselves, and their family whether leprosy existed in the family, and whether it was known that they had gone to America. It might then be ascertained from what source they got their passage money, and whether they had ever been assessed by the Poor Board, or otherwise. The district of Stavanger is not a specially infected district as you seem to believe. At the end of 1885 it had only fifty-six lepers living out of the asylums, while the district of Bergenhuns had at that time one hundred and fifty-six. I am bound to repeat that in my opinion, no authorities of that district would have thought of throwing off the leprous women to let America take future charge of them. The regulations now in force in Norway regarding the lepers, are contained in the laws of June 6, 1885, on separation of lepers, and treatment of them in public asylums or hospitals. The

Leprosy.

law prescribes that lepers shall not be lodged with private people at public expense, but in case of needing public assistance, they shall, by the Poor Boards, be admitted to the public asylums. If destitute lepers are not treated in such asylums, they shall either be kept in separate dwelling rooms, or be treated in such way as the Boards of Health may deem sufficiently safe. The law prescribes also that other lepers (beside the destitute ones) may also be ordered by the Board of Health to live separate from their family and friends, and if such order should be disobeyed they shall also be treated at the public asylums. Rooms, clothing, bedding and other effects which have been used by lepers must not be in use by, or be handed over to, other persons without being previously disinfected by order of the respective Boards of Health. The proper way to prevent lepers from emigrating to America in the future would, in my opinion, be to bring the subject before the American Government, which then probably would insist with the Government of Norway, that a strict and scrupulous medical examination be made of all emigrants from the western districts of Norway. It is not in my power, as consul at Christiana, where no leprosy exists, to take any steps against that emigration, of which you justly complain. I will add to my foregoing observations, that more than ten years ago leprosy was introduced into the northwestern States of the United States, through emigrants from Norway, and that Prof. Boeck, the celebrated dermatologist, had himself made careful inquiries in America about the Norwegian people there, who had brought the disease with them from the old country. Also, Dr. Armaner Hansen, a well-known specialist in the treatment of leprosy, went to America to visit these lepers of Norwegian origin. I have tried to give this important subject my best attention, and will be glad to learn that through diplomatic intervention, some effective means may be found to stop further introduction of the disease into the United States. If I can do anything to attain this end, I will consider myself very happy.

Very respectfully,

GERHARD GADE,

U. S. Consul. •

Accompanying the foregoing letter, was a copy of a printed circular of regulations in force at Christiana.

The foregoing correspondence was referred to Senator W. B. Allison, member of Congress from this State, to-wit:

STATE BOARD OF HEALTH,

OFFICE OF THE SECRETARY, Sept. 1, 1888. ( }

HON. W. B. ALLISON, M. C.-Dear Sir: I desire to call your attention to the enclosed letter from Gerhard Gade, U. S. Consul at Christiana, Norway, replying to a communication from this office in regard to the exportation of lepers from Norway into this State.

In March last was reported to the State Board of Health, a case of leprosy in the person of a young woman aged twenty-four years recently arrived direct from Stavanger, Norway. She had been affected for ten years. The