in the past, and New Orleans in the present, alarming numbers come to light. Just now the point most threatened is New Orleans, for no legal barrier stands to protect the great city which, after a long and dreadful struggle, has lately gained the mastery of tropical yellow fever by quarantine. The successful method of Ulloa and Miro is forgotten or unheeded by the authorities, and must be rediscovered to save the people from the fate of the Hawaiians. Here in California the enemy, few and scattered, is in our midst, and others are liable to come on every ship from China and the Islands; but we have been fully warned, and are armed with lawful weapons. It is our own fault if they do not protect us. One other provision is needed-a State hospital for lepers. Our statutes enable local authorities to act for themselves, but not one of the counties has a suitable lazaretto. San Francisco has always had more than half the lepers in the State, but its only accommodation is the pesthouse, where lepers and smallpox cases are lodged in the same house. That the lepers escape smallpox, and the smallpox patients escape leprosy, is rather good luck than good management. At least one leper has died of smallpox, and some leper of the future may be reminded of a former residence at the same institution for the other complaint. Apart from such improper association of subjects of the two diseases, the pesthouse is an insecure place. Only lately a leper in a far advanced stage has been recommitted, who escaped two and one half years ago, and was at large in the city during the whole interval. A small island near San Francisco would be the proper site for a lazaretto, and accommodations for one hundred lepers would be enough for present and prospective needs, inasmuch as most of the cases have hitherto been sent back to China. It has also been suggested that a contract be made, if possible, with the Hawaiian Government, to have all lepers cared for at the leper settlement on Molokai. I In Louisiana there is imperative need of such an institution and of legislation equivalent to the Act of California. As to the other States, it would be sufficient to pass the necessary isolation Act, and leave its execution to the State Board of Health, with power to draw warrants the treasury, not to exceed a fixed amount, for the expenses. upon would not be understood as encouraging any alarm on this subject, even in Louisiana or California. Our State needs only faithful enforcement of existing laws, with a suitable lazaretto, while Louisiana would be saved by a revival of the forgotten plan of Miro, which was successfully in operation just a century ago. In conclusion, I would not be unmindful of courtesies and assistance rendered in the collection of data for this paper, from a large number of correspondents at home and abroad. They are too numerous for individual mention, further than is already indicated. Among them, officers of Health Boards have rendered especial service. To all I tender sincere thanks. LEPROSY. By WOLFRED NELSON, C.M., M.D., Member College Physicians and Surgeons, Province of Quebec; late Member State Board of Health, Panama, etc. In the spring of 1888 it was my good fortune to pass some time in the island of Trinidad. While there (thanks to the courtesy of the Surgeon-General of the island, S. Leonard Crane, M.D., C.M.G.) I was given the entrée of the hospitals, convalescent_homes, etc., over which he so ably presides. At the leper asylum I was introduced to Dr. Beaven Lake, in charge of the asylum, and was allowed to see the patients under his care and make a series of photographs. Six of the illustrations hereafter were made at the asylum, and the remaining two cases of elephantiasis-were made at another institution, partly medical and partly charitable. Now to consider the illustrations: Case of tubercular leprosy; patient, a negro from Venezuela, aged eighteen. He had been in the asylum since 1881. He was going from Three years previous to my visit, Dr. Rake had removed bad to worse. He several tubercles from his face. They reappeared within a year. was a fearful looking object. Some of the tubercular masses were ulcerating or breaking down. Face, ears, wrists, and hands in places were masses of large tubercular growths. AT CASE NO. 2. The same subject, showing the left side of the face. Masses of tubercles on some of the fingers were bandaged. His general health was good. Dr. Rake informed me that the average duration of life in tubercular cases was eight or nine years. The Asylum Reports, page 24 of 1887, give a history of the case. When the eyes are involved, as they often are, the disease begins in the conjunctive. Later there is corneal infiltration. Iridectomy gives temporary relief. The sight soon goes. CASE NO. 3. Mixed case of leprosy; patient, a Chinaman. The tubercular growths did not trouble him very much. Dr. Rake was constantly removing dead bone in this case, and opening sinuses in the feet. Man, aged forty. Had been in the asylum three years. He must have acquired the disease in the island of Trinidad, as he left China many, many years ago. Patient, a white woman-a creole of Trinidad; aged about forty-five; probably of Portuguese descent. Face shows nothing, and has escaped. The deformity of the hands was great-an anesthetic case. age duration of life in anesthetic cases is ten years. The aver |