REPORT OF THE STATE BOARD OF HEALTH.

had escaped entirely. He was looking down while I was making the photograph, which will account for the drooping lids as seen in cut. One would fancy ptosis was present.

Strange as it may seem, many of the lepers, practically without fingers, have acquired a certain dexterity; can use knife and fork, and lift buckets, etc. It seems so strange to see nails growing over the knuckles, but the explanation is simple: the bones have been absorbed and the skin contracts, hence the nails.

It

Many of the lepers are allowed to do light work-gardening, etc. keeps them employed and fairly happy. As a whole, they seem a contented lot. They receive the best of care, and have excellent quarters, etc.

CASE NO. 6.

Dr. Rake removed a cat

Patient, a negro; a very interesting case. aract, and got good vision. He published an account of this case in "The Lancet," London, 1886. Patient's vision when I saw him, in 1888, was excellent. His left wrist was full of fluid. By compressing the parts the ends of the denuded bones communicated a grating sensation, as in Charcot's disease. The left carpus can be dislocated any way

CASE 7.

Patient tottered

you like. Left hand was bent at a right angle to arm. in walking like an ataxic. A fellow patient had to hold him steady while I was taking the photograph. This case was deemed a very interesting one, and the novelty was to know whether the leprosy had invaded

the cord, or was it locomotor ataxia properly so called. An anesthetic

case.

CASES No. 7.

The men on the reader's right and left are coolies (i. e., East Indians, employed as laborers on the sugar estates). They both have Elephantiasis Arabum. The man in the center is a West Indian negro, having Elephantiasis Græcorum. The former is not associated with leprosy, while the latter is occasionally, but only occasionally. Below are their legs:

The right leg of the patient on the reader's left was a mass of warty growths. The left leg of the negro in the center was a large, misshapen The case on the reader's right shows uniform infiltration, or enlargement of both legs.

mass.

As much confusion exists in the ordinary medical mind regarding leprosy and its connection with elephantiasis, I purposely photographed the legs and their proprietors. As has been stated, Elephantiasis Arabum is not associated with leprosy, while the Elephantiasis Græcorum may be, but only occasionally.

Elephantiasis is said to be due to the filaria sanguinis hominis; but the latter is found only in some cases. Ligating the femoral for a cure is deemed a very doubtful expedient, as collateral circulation soon sets up, when the old condition obtains.

Dr. Rake is of the opinion that gangrene has been a direct result of the operation. (See Asylum Reports.) In certain cases, free incisions and drainage give relief to a certain extent, but the fluid soon accumulates again. Such cases are hopeless, unless you amputate. Dr. Rake met with a case of leprosy of face in a boy, associated with elephantiasis. The leg was amputated, but at the end of a fortnight pyæmia developed and killed the patient.

REPORT OF THE STATE BOARD OF HEALTH.

Many years ago, when I was a mere lad, my father, the late Dr. Horace Nelson, of Montreal, amputated a leg four inches above the knee, for Elephantiasis Græcorum. The patient was a French Canadian; recovery was perfect. The leg is in the Museum Medical Faculty of McGill College, Montreal.

I have heard of but one case of leprosy in Montreal. It occurred many years ago, and it came under the observation of the late Dr. R. Palmer Howard, who for some days was sorely puzzled by it, but later diagnosed it correctly..

So much for the photographs. I have others by me, but owing to my leaving for England and the Continent earlier than usual, I cannot report them at present.

Now for a few general considerations regarding leprosy, a disease, by the way, that of late has made much unnecessary stir, great sensationalism, as well as causing gross injustices, if not positive cruelty, to sevA few facts, and no eral unfortunates discovered in the United States. theory, regarding this most ancient of diseases: During my five years at Panama, and extensive traveling since, all within the Tropics, I have seen a great deal of the disease. All along the Spanish Main it may be found; also in the West Indies. It is not confined to the lower classes. Dr. Rake's opinion regarding its cause is that shared by all the stuHe deems the predisposing causes, dents of the disease known to me. bad food, bad ventilation, and neglect of personal hygiene; or, in other words, the same causes that predispose to phthisis predispose to it. He says that the parallel between leprosy and phthisis is an extraordinary one. The bacilli of the two diseases respond to the same chemical tests; the enlargement of the glands, the caseation, etc., being identical with phthisis. The latter disease gives the heaviest mortality among lepers, causing a fourth of all the deaths at the asylum at Trinidad.

Years ago, while studying the disease at Panama, it was thought by Some writers that sexual connection was the means par excellence for propagating the disease. It is not at all unusual to find a married couple, one of whom may be a leper, and the issue may wholly escape

the disease.

In the Sandwich Islands, of thirty or forty children born to lepers, but a very small proportion have inherited the disease, two or three per centum only. (See Report Board of Health, Honolulu, 1886.)

Is leprosy in any sense contagious, as we understand contagion? Dr. Rake says that it is not. Such is my opinion. Inoculations made by him at the hospital have failed to produce the disease. (See Island Reports, 1886.) Finally, I do not know a single physician familiar with the disease who deems it contagious. All the evidence is quite the

other way.

"Not one," said she.

"Pray remem

While in Trinidad I asked the Sister of Charity in charge of the Apothecaries' department how long she had been there. Her reply was six and twenty years. I then asked if any Sister of Charity had ever shown any signs of the disease. ber, six and twenty years within a lepers' asylum." A Lady Superior and eight Sisters of Charity, nearly all French women, have charge of the asylum. They are noble women, passing their days among the "living dead." No interviews, no praise from princes, give them publicity; they are satisfied to do their duty without parading it before the world.

Had leprosy been a highly contagious disease how can one explain their immunity?

The Surgeon-General, a gentleman of life-long experience, is no believer in its contagiousness.

It will be safe to state that the danger from lepers is almost wholly imaginary, and exists in the minds of a few medical men in this country who seem to adopt the sensational views of the lay press.

At home, in Canada, Dr. Smith, who has been making careful inquiry among the lepers at and near Tracadie, New Brunswick, states emphatically that it is dying out.

As to treatment: Leprosy practically is incurable; hence, treatment practically is nil. Cleanliness, good diet, fresh air, etc., meet the general indications. Some remedies, such as arsenic, chalmangra oil, etc., and i change of scene, are said to be useful. At times slight changes for the better may be noted, but they are temporary. Upon a return to their old habitat the disease resumes its sway. The treatment consists in meeting complications as they arise.

Dr. George Dock, of Galveston, Texas, found two well marked cases in that city-native cases, if I may so term them. He read a paper on them last year at the meeting of the Texas State Medical Association at San Antonio. One of his cases sent to Colorado, improved. The other was stationary-a well marked case, tubercular of many years' standing; man's wife shows no signs of it.

Dr. Guiteras, now of Philadelphia, formerly of Charleston, South Carolina, told me some years ago, when we met in Florida, of seven cases studied by him in Charleston; all Americans, if I remember rightly.

Quite recently, when in New Orleans, Dr. Austin, who has practiced there a lifetime, told me of some fifteen cases. He did not deem it contagious, or that it was increasing. He also is fully of Dr. Rake's opinion that the disease is due to bad hygienic conditions, etc.

One day while in the Post Office in Little Rock, Arkansas, I saw a wellmarked tubercular case.

In a letter to me from Dr. Beaven Rake, of date April 23, 1890, he reaffirms his view that leprosy is not contagious, as we understand contagion. He also adds that some authorities deny that it is hereditary.

This isolating of lepers by taking them from their families, is cruel and wicked. Phthisics, we know, are sources of great danger, yet we do nothing. They travel in sleeping cars, expectorate everywhere, yet nothing is said. We do nothing to isolate syphilitics. The sensational articles in the lay press have been adopted by a large section of medical men as gospel. Let us, as intelligent medical men, keep to facts. Let us be just, and not lend ourselves to assisting in oppressing the sick and afflicted. Let us speak knowingly or be silent. Some of the enactments regarding lepers in this country are a blot on legislation, and an admission of ignorance that is wholly incomprehensible to any student of leprosy.

No. 32 NASSAU STREET, NEW YORK CITY, August 4, 1890.

RECENT PROGRESS OF SANITATION IN CALIFORNIA, AND OUR PRESENT SANITARY NEEDS.

By W. R. CLUNESS, M.D., Sacramento.

(A paper read before the State Medical Society.)

Having reluctantly accepted an appointment to address this society on some subject relating to public hygiene, I would respectfully invite your attention to a brief review of the sanitary legislation which was. effected at the last biennial session of our Legislature, in 1889, together with some remarks on other measures deemed of hygienic importance. The last Biennial Report of the State Board of Health, published in the latter part of 1888, contained some quite severe reflections of the Secretary upon the neglect of the previous Legislature of the State to recognize its sanitary needs, as evidenced by its failure to pass any sanitary bills, except one appropriating $10,000 for an emergency fund, to be used as far as necessary for excluding infectious diseases from the State. These remarks of the Secretary were resented by some of the Senators who held over and sat in the Legislature of 1889, and for a short time he was one of the best hated officials in the State. None the less, his caustic words had a salutary effect on both branches of our law makers at the last session, and we have to rejoice in an unusual number of Acts of real utility to the State. These are as follows:

Senate Bill No. 11 was an Act to provide for the proper sanitary condition of factories and workshops, and the preservation of the health of the employés. It applies to all establishments where five or more persons are employed, and the Commissioner of the Bureau of Labor Statistics is required to enforce its provisions. The provisions mainly apply to foul effluvia, suitable water-closets separate for the sexes, ventilation, underground apartments in bad sanitary condition, mechanical contrivances for obviation of injurious gases, dust, etc., and seats for females when not required to be on their feet.

The Commissioner, Hon. J. J. Tobin, reports upon the execution of the Act as follows:

When the Act to provide for the proper sanitary condition of factories and workshops was passed, it was intended that this bureau should be supplied with the means to enforce it, consequently the appropriation was increased so that the Commissioner could employ an assistant, whose special duty would be the inspection of factories and workshops, and the enforcement of the law. The Governor vetoed this appropriation, and, as have to continue the statistical work for which all labor bureaus have been designed, I have been obliged to confine the work of inspection to narrower limits than if otherwise provided. As you are aware, our manufacturing industry in California is very limited indeed. The sanitary condition of our factories and workshops and canneries, except where conducted by Chinese, is, on the whole, very satisfactory. I was obliged to condemn some undergound workshops where women were employed as seamstresses, and cellars where bakers were making bread. In some instances, where I had doubts as to the unhealthiness of the premises, I called upon the San Francisco Board of Health, and was guided by their advice. We have not yet reached that stage of density of population and lack of room for extensive factories and workshops when capitalists will be disposed to sacrifice the health of their employés rather than incur expense. A short time ago 1 issued a special report on the unhealthy condition and surroundings of the cigar factories of Chinatown in San Francisco.