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1845 Notes, Short Comments, and Answers to Correspondents. THE LEPER IN THIS COUNTRY. THE remarks below are suggested by a letter from a correspondent who has inquired as to the accommodation of the leper in England. Leprosy may be regarded at the present time as a disease of uncivilised or partly civilised races; but it may occasionally, though very rarely, happen. that a European acquires the infection when living abroad in close relations with infected natives. Unfortunately, the etiology of the disease still remains obscure. It may, however, be asserted with confidence that the danger of leprosy spreading in England (as has been suggested) is, under present conditions, practi- -cally nil. When, however, a person returned from abroad is discovered in this country to be suffering from the malady it is -essential that he should be isolated as far as is practicable, and that - strict antiseptic precautions should be taken. These measures Ynvolve expense, and if the patient or his relatives are unable to defray the cost the duty would appear to devolve upon the guardians -of the poor for the district in which the infected person resides. The disease persists for years, and there is as yet no trustworthy remedy or method of treatment known that can be relied upon to cut short ’the disease or cure it. The cases that occur in England are few in number, and we know of no special hospital or institution provided for such patients. The Poor-law authorities, we believe, have sought upon occasion to transfer the responsibility of isolating the im- pecunious leper from their own shoulders to those of the sanitary authority; but we understand that it has been made clear that the guardians and not the district or town councils are responsible. If a leper were known to have been admitted te a general hos- pital a panic would probably follow, with possibly a stampede - of every patient who could get up on his feet. The lot of the European leper is indeed an unhappy one, for he is shunned by all, and his presence, if observed, creates great alarm, if not panic. In our opinion, however, so long as proper attention continues to be paid to general hygiene, and so long as surgical cleanliness of the patient is stringently observed, there is practically no likelihood that -the infection of leprosy will spread in this country from the sick man to those who wait upon him. So that even in a general hospital, if he had a room to himself and his presence was unknown to the other patients, no harm would be done. And the same can be said of a workhouse or Poor-law infirmary, always provided that the measures we have indicated above are strictly carried out. COLOTOMY DRESSINGS. To the Edito1’ of THE LAxcET. SIR,-Can you or any of your readers give me any suggestions for a form of apparatas for retaining dressings to enable a patient to get :about with a colotorry opening close to the cseeum. I shall be very much obliged for any suggestions.. At present a dressing is needed on an average at intervals of an hour and a half, and, of course, the faecal material is very liquid.-I am, Sir, yours faithfully, M. G. LESLIE WALKER, M.B. Holly Bank, Crosshills, near Keighley, June 19th, 1913. - "’** The chief indications are to diminish the odour and to thicken the fsecal matter. To diminish the odour, the administration of charcoal by the mouth is very useful; it may be given in the form of powder or of biscuits. Some chalk mixture will generally diminish the fluidity of the contents of the bowel. There are several forms of apparatus sold for the purpose of covering a colotomy opening; the most convenient form consists of a hollow cup with a central stem, packed with some absorbent dressing. The cup is kept in position , by straps.-ED. L. , CLIMATE AND HEALTH OF THE EAST AFRICA PROTECTORATE. A REPORT on the Blue-book of the East Africa Protectorate for 1911-12 has been received at the Colonial Office and presented to Parliament. It states, inter alia, that the climate of the Protectorate varies within wide limits-from the extremes of tropical vegetation to the snow line. At the higher altitudes of 4500 feet to 9000 feet the climate is bracing and healthy. The mean maximum temperature registered at Nairobi (5450 feet) for 1911 was 74-50, and the average monthly rainfall 3’51 inches. At the coast port of Mombasa the mean maximum tem- perature was 82’30 and the average monthly rainfall 3’46 inches, whilst the lake port of Kisumu had a mean maximum temperature of 83 50 and an average monthly rainfall of 3’03 inches. The census returns for 1911 give the white population of the Protectorate as 3175 and Asiatics as 11,886. In the absence of a census of the native population it is only possible to make a rough calculation, and this, based on hut tax returns and other indications, is estimated at 3,000,000. During the year 92 births were registered amongst the white population, giving a ratio of 28’97 pf-r. 1000. The number of deaths registered was 42, or a ratio of 13’22 per 1000. No information ° regarding births and deaths in the different native tribes is available. The general health of the white population has been good. The total i number of Europeans admitted to the Government Hospitals at I Nairobi and Mombasa during the year was 230, and of this number 14 died. The principal ailments were enteric fever (21), malaria (76). blackwater fever (4), nervous diseases (5), respiratory diseases (10), digestive diseases (34), and injuries (19). Of the 21 cases of enteric fever, 17 occurred in and about Nairobi, and of the total cases treated 3 proved fatal. Though it has been found difficult to trace the source of infection, it must be assumed that the majority of patients contracted i the disease through drinking water from streams which were known B to be polluted. During the year Nairobi suffered its third visitation ’ of plague, the epidemic lasting from May to September. In all there were 39 cases, 22 of whom died; the cases were confined to Indians and Africans. 6140 persons were inoculated. The European death- rate in Nairobi has increased from 8’3 to 21 per 1000, largely due to excessive infant mortality early in the year, and to deaths in hospital of patients coming from other parts of the country. At the coast dysentery was somewhat prevalent amongst natives and in and about Mombasa. The causes, as far as can be ascertained, are bad water, food of poor quality, non-hygienic surroundings and conditions, housing, camps, and clothing. Kisumu experienced its annual re- currence of plague. Altogether 64 cases occurred, with a mortality of 49; here, again, the cases were confined to Indians and Africans. The European population is so scattered throughout the Protec- torate that it is difficult to obtain any reliable medical statistics regarding them. It is only for emergencies and urgent cases that the services of Government medical officers are requisitioned. These calls were comparatively few, and it may be said that a fair measure of health was enjoyed during the year. As to European officials, the statistics show that their general health was good. There is an observed tendency to take more care of their health than formerly. Out of an average number resident of 388 the average daily number on the sick list was 9, and the total deaths for the year 3. At the coast the most effective measures for the eradication of mosquitoes have been bush clearing and the oiling of pools and marshes. Continuous inspections of the various quarters of the town of Mombasa have been made by the health officer, but the machinery to enforce his recommendations being carried out still remains in an unsatisfactory state. Mombasa still remains dependent on underground rain tanks and polluted wells for its water-supply, but the preliminary work of the new pipe water-supply from the Shimba hills has been begun. In coast towns the drains, where they exist, are usually built of concrete and discharge into the sea. The condition of the undrained areas is far from satisfactory. At Nairobi the water-supply remains of excellent quality, and a larger pipe line from the source to the township was laid down during the year, with the result that. instead of seven gallons per head per day, 30 gallons are now available. It is unfortunate that the Nairobi River, running through the township and known to be infected with typhoid germs, is so convenient of access to a large number of the native inhabitants. This is doubtless the main cause of the periodical outbreaks of enteric fever which have been experienced. At Kisumu, during the rainy months of the year, malarlt and plague were most prevalent, and owing to their existence much attention was paid to the sanitation of the town. 5728 persons were inoculated against plague and 10 435 rats were trapped. Isolation of sick and contacts, evacuation of huts. general disinfection, and safeguards from rat infection were the chief precautions adopted during the outbreak. The main water-supply of Kisumu depends on a pipe installation operated by a pump placed at the dead end of the shallow gulf on which the town is situated. This lake water is grossly contaminated with vegetable matter, and the churning up of the mud by the constant succession of arriving and departing steamers, and, as a possible source of typhoid, cannot but be regarded with grave suspicion. Great attention has been paid to the clearing of the bush which used to surround the township and was the favourite habitat of the Glossina palpalis, and the foreshore for some miles on either side of the port is now free from infection. Malaria exists in townships generally to a greater extent than it should, and is even found in places where it should never have been allowed to get a hold. The European Government Hospital at Nairobi is a well-equipped modern building, but the one at Momhasa is a converted bungalow, not wholly suitable as a hospital. Although primarily intended for Government officials, these hospitals are more largely used by the general white population. Both of them are under the charge of a medical officer and nursing sisters, and have a sufficient menial native staff. At each of the headquarters stations of the provinces there is a native civil hospital in the charge of a medical officer. In addition, there are some 20 dispensarit s, to most of which is attached a small hospital in charge of either an Indian sub-assistant surgeon or a compounder. These dispensaries are periodically visited, inspected, and reported on by the medical officer of the province in which they are situated. Both hospitals and dispensaries are, in nearly every instance, built of corrugated iron and wood; and huts are built of wattle and daub as required to segregate cases of infec- tious disease. 5548 indoor patients were admitted to native hospitals and dispensaries during the year, and of these 592 died. The number of outdoor patients treated was 80,222.
