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Tous las autras axamplairas originaux sont filmAs an commandant par la pramiira paga qui comporta una amprainta d'impraasion ou d'illustration at an tarminant par la darni*ra paga qui comporta una talla amprainta. Un daa symbolas suivants spparaitra sur la darniira imaga da chaqua microfiche, salon la cas: la symbols -^' signifia "A SUIVRE' , la symbols V signifia "FIN". Las cartaa, planchaa, tableaux, ate. pauvant Atra filmAs A das taux da reduction diff«rents. Lorsqua la document est trop grand pour £tre reproduit en un seul clich*. il est film* * partir da I'angia sup*rieur gauche, de gauche * droite. et da haut en baa, 9n prenant la nombre d'imagea n*cessaira. Lea diagrammas suivants illustrant la mithoda. 1 2 3 4 5 6 L LEPROSY. LEPRE QUESTIONS REGARDING LEPROSY. ENQUIRY MADE BY THE HAAVAIIAN OOVERNMENT. ForefgrAffairS? iS^Elr^rtw? ?^ ^is Excellency the Minister of Hawaiian Consul-GeneralTn cSa ^*"' ^^~"«'' ^'- ^- *:"i°" Anderson; NEW BRUNSWICK. ->tSro1t^L?gK^riL*^ Dr. A. C. Smith, M.D. & CM Member'nf ^tt S^'"','^"" °^ Agriculture, and of Visiting Physician of the Tridie Lazarel. ^°""°" °^^°^ Brunswick. Mr. Tachi's answers:— Ottawa, June, 1886. ""• ~''rhTL!irertLV'p:r\7f T'Cv^^ -p-^ ^^ Northumberland, that section of thoCnntry JZs X L^'^ Brunswiclr, ,n Canada does STr^w" r eCr: CnS Sir T ^'"T^^"'^ '^— '^ - it manifested externa yb^nseSbiUtrmf.?,^ a specific character. It is ations of the «kin, pLph Z 3 «^tensire color- and ulcerations. 8ma7 tumours Tt„Iui!^'" ('?°'.g«»ie'ali8ed). ulcers acces.es, loss of extremilioraXthK so^ 'so^^^f ^^^^^^^^^^ P^T-"" to the disease, and some simply concortrtTe8iorofmZ,''*r°°"" occurrence in the course of tL ma^v 7hi »t ? °i°».ore or less frequent «yncope, coma, marasmus or cacheJS" "''°'' ''"'"'« ^^ suffocation, * The queries are thus prufacei :— Uon more particularly desired sm to the n~lalfnL'^*',•'?K'''^''' "'P'°l^'^« tliem iu full The iifo™^ custom, lepers are delu ,Wth, the a °coma>K^n"movMld%o'/r'n; 1!"",^ '" '^'"«'>' b/ >«w « ^ d^VJS."''" ^''«" »-""■« - "^^ q-stion\"K'ltp1o^?; 1^'oT »c^r«l';^^ireaTst'g^"j' "HoKoiPLD, aoth December, 1884." S-800 QUESTIONS SUR LA LEPRE ENQU£:TE DU GOUVfiliNEMKNT D'HAOUAI. il.«.n^l**°°T '^'■'"^"'•ogatoire ♦ gonmia par Son Exnollerre lo rainiatre des Affaires NOUVEAU-BItUNSVriCii. dTMIeDrl O Smifh M n^V?, u^°""''"u '"^P"*^ ™''"'^t.o do rARricuKure, et > Wict m£;i Vi 'a "wcf^do^xS '" ^°''"" ^^'^'°'" '^" Nfuveau-Brun. IMponses do M. Tachfi : — Ottaoua, Jain 18f6. "observfias." prmcipaui c»ractArei dutinotifi de ohaone dei formes pur tom careTra^s:i^a^sr^''^--' >« goue^t^^r:*' «„ m^nip L^ f? ?*™ aillonra, oomrae maladio sp^cifiqao et chroniqae Elle Vendues do ir™».?T"'"* ^ '^^ ''»°««th^8ie, Ltac^es ot dos colomtfo"' i!«nwi.' ^^.^ ^=^^8 «t do8 ulcdratioDB, de pet.tes tnmenrs (tnheroalesf des BenleEtoornmlin.i? ♦'' ^' °°' partioaliewAlanTaladio, Iob futres rcor.lra?ar:t'.l^SV.1I"™'"''"* ^^^ '" -ff-«''-. •'^ «y-ope. * Priambule dee questions pos^s :— d.,Q';i5:i^•at3«teA'uttte^«■ L^^^^^ briUnaWue. n^ un «o«It6 meat soSntifique do plusieuw Sea aueation. On . =, f , ,!^'°'^""'? *"=""«■•. ni^lprfi le caractAre pura- •olt de la oharitfc privAe, ettoi lea fait. anirr.ft^rh.SI^if' '*■ •'"M.qu'il" re?oiTent, soU de I'Btat ••t conUgleuse aux div^rsea ptiodes de 3oL Ifi^el^pXnt '""' "^° ' " ""' "" '""' '" "P" " Ho»OLCLn, 20 dicembre 1884." a. I httve obsorvod, in Now Brunswick, what in meant by the words " tuboroolur leprosy " and " aniOHthetio leprosy," of many authors, or by the words " phymatod leprosy " and " aphymatod loprosy," of other writers. What I have to say on this question applies also to other distinctions, made by not a low, under the various titles of " macular leprosy," lepra mutilans, " mixed lepnsy," &c. All these cla88ificatio''s aro bused on the presence, absence or more or Iosh consjiiouons appearance of certain symptoms. b. These so called f»rms, in my opinion, are the result of one common morbid state Anicsthesia is invariably present, to n greater or lessor degree, in soma part of tho body, iu all oases of leprosy ; it is therefore difliuult to under- stand how it can bo mode to characterise any particular form. It was from tho consideration of the uniform presence of the analgesic state in some portion of theacoossiblo surface of the body of tho loper that the Colloga of Physicians of London, in tboir report on leprosy, proposed to substitaco tho term " non-tuborculato " for the term " aDtusthotic." Tuborculos are often times absent ; but inasmuch as those small tumours are only one of the manifestations of a process which affects, not simply the ekin, but also tho nerve structures and other tissues, tho absence or presence of these papules, at a given moment or at any time, soem'j hardly sufficient to warrant an addition to tho noraondature. All this, however, is said without losing sight of the great importance of that symptom. Aly answer to the second pai-t of question b is easily suriuised, from what I have already expressed. That which does not constitute, in my opin- ion, difTorent forms of tho distemper, cannot bo for rao, " spcciticaliy distinct diseases, having no affinity with each other." Leprosy, to my mind, is one indivisible morbid entity, so to speak, although, as in o'.hor ailments, its outward manifest alions aro not all produced in every case, and never to be all met together at a given moraont, in tho same individual. It is not, moreover, anrosthosia, macuto pemphigus, tuborculos, destruction of sub- stance, which constitute per se tho essence of leprosy : those trophic lesions are seen in other dihoasos ; they succeed traumatit^ra of tho nerves ; they aro produced on animals by nervous irritation. What characterises the disease is tho specific labour which produces thorn, in tho particular way they pre- sent themselves in f'is affection — to the modical observer in shape, colour, odour, mode of evolution — to the modical philosopher in unalogios, difforonoes, cauces, elTocts logically deduced from evidence and history. c, I have already given the more obvious characters of U^proay which I have seen; but I do not take any of them as distinguishing different forms of the disease. Most of the outward symptoms of leprosy are apt to be absent, to appear, disappear and reappear, succeeding and, as it were, supplanting each other, under tho operation of ono spocifio irritative force, during the long course of the sickness. I opine, with all due deference for the opinions of others, that such a succession and change of phenomena, all due to tho same eKciting agency, constitute a morbid unity, and cannot establish a basis upon which those forms can bo buili. To uutdou the study of tho disease with snob distinctions and names, is, I humbly but.firmly hold, complicating matters, without any adequate compensation, especially when attempts are made to carry these distinctions so far as to separately describe the progress of tho disease throughout. Q. a.— -"At ^hat age does the disease generally maaifegt itself, and what are asually the earliest " symptoms observable?" A. 2. — The disease generally manifests itoolf ufUjr puberty, in grown-up adults and middle aged individuals; but it comes at almost all ages: early infanoy, however, seems to bo entirely exempt from tho malady. Children are not frequently attacked by leprosy, and it i^ rarely objorved to begin id old age. a. J'tti olworv*, dans lo Nouveau-Brunswick, co qu'on dtisigao uai- lu-i mota— " ;dpre tuborculeuiw " et " Idpro anosthisiquo '" ilo boaaoovi) (f'uutours ot par lea mots—" lopie phymatodo " ot " Idpre aphymatode d'uutros 6crivaina. Co que j'ai H diro sur colte question s'appliquo eiiooro A d'antres distinctions mloptdoH pur pluHiours, «oa« Iom noms do—" idpre mauuido, ' de— " iipre mu' tilante," do " Idpro raixte " ot autre». Toutes coh cia«.(iaoation8 nofU tbnd4«» U pr^iionce, I'absenoo ou te plusou raoiuc d'apparonoe ue oertaino Hvmt>- t6me8. •' •^ b. Ces pr<5tendue8 formes »ont, dans mon opinion, dea inan.fi-stations d'un dtat morbido cotntnun d toates. Ii'ai.e8th6iio se rencontre toajoarH, pluo ou moins, quelquo part choz le Idprcax ; il est ditflcile, par concdquont, do coinprendro oommout co Hymp> tdmo pent oaracUiriHer uno formo particuliire. Cost oetlo tionsiddration de la presence constanto de l'6tat analgMquu, dans quolqiio portion do la sat^ faoo acoossiblo du corps dos lopeux, qui a engag6 lo Oolldgo dot mddocins do JjondroH, dans son rapport sur la Idpro, A sugtjdrer les mots "uontuber- oul^o " h la place du mot " unestb^sique " Les tubaroulos ne noiit pas toujours prdsonts ; mais lour absonco ou lear pr6-ienco ne somble pas un motil sufflsant d'ajuator a la nomenolaturo attcndu que ces petites tumours ne sent qu'uno do.^ nombrousos raanife^ tations oxt^rioures d'un nrocesxus qui uffocto non souloment la peau mais anssi bien la structure dos norfs ot d'autros tinsus Ea co disant jo n'ontends nullement mioouuaitro In grando importauoo du syraptorao de la pon^sio des tubercules. Ma riponso A la socnmlo pat tie do la question b, so il^Juit fiiciloment de de CO quo jo viens de dire. Co qui no constituo pas, pour moi, dcs formes dis- tinctosnosauraitmo ropre^ontor "des maladies sans aflinito ontre olios." A mes yeux la idpro est une entity morbide indivisible, qu'on mo passe I'oxpros- sion ; mais, comme cola a liou pour d'aatros affections, tous lea symptomos ne so raanifostont pas chcz tous les malados, ot no so renoontrent jamais toua 4 la fois et dans un moment donn6 sur le memo individu. 0^ no sont ni I'anesthdBie, ni les tachoi", ni le pemphigus, ni les tubaroulos, ni los mutila- tions qui, de soi, constituent re'pr«i oombl«D de Umpi derlent-elle ordIn«lrem«'" J6p«..dout do la Jrlodo do H„ 1 ^ ''^"«"«.'>"« * f»'l 80" apparition et do m dur<5o. Uh pnwrds ot la dunSe do 1 affection oocupent un OHpiico do to.nps qui vario bouucoup : dan« oortaiDH cas olle ditruit so« viclimcs en pou d'annfieH, danfl d'aatros can lu m« adio dure pluBienrH ann^oH ot daoH quolquos can mfimo ano longuo p^riodo do tempH. Je no mo tern pa.M on moMuro do dormer uno moyonno do la durdo r^ ..itP'®' *'*'• qoeft'O" entralno I'oxanien do conmdirations multiple.. ^nu'irproblftZ.'''''' ''" '' P""'°"' ^"'^ '"^«''''~' f-- partio'doB- donzo ann^os do dur^ est aesoz comrauu pu, Iob Jcux «oxo8. Dann cortai.m oas exceptionnels los lonte proKros ot la virulence atiinu,5o do la maiadie ont SfJ"?'L""* ""m'"*^!" *^® """■*. ^'^^ '""K'eraP'' »t 'lo jouir d'ono santd relativc- mont bonne : il ho trouvo mamtenant, dans lo lazarot du Nouveau-BrunHwick deux femmeschez qui la maladio a exists sann intorrnption, bicn quo parfois lesByraptamoB fusBont obBcnrclB. pendant «u moin« quBrinlo«ii ot trento Bant* profonddment alt6reo, oncoro moinH d'une dostruction procTmino II SixTni '^ ^°"™ derniora uno Alio chcz qui la maladio a durd vlngt- „... " "'""'; .8"^''^ P«8^'blo dVwHignor dos phases rfig.ilidres A la Idp.-o, tant cette maladio est capriciouBe Jans ses manifeaUtTorm ot dans sadur6o- boancoup dos Wsions locales, corarao jo I'ai ddjA dit, sont Hujottes A do fr6- qwnd on dJcouvre quelques uns dos signes patho^'nomoniquos ot quo^e pro- ZTr^r, '*' f^f""!^ "'^ "PP"?" *• "^^ «"'^ P'-t^ * croiro\uo c'ost par ,So^ seulomont qu'il faut compter lo temps de la p^riode d'invasion, V,ondan1 te V] '""^'''^P'* "P'**' l«°»«l»do pout ignoror ou cacher Hon iUt : la 3«n . *^ premiers symptdmos et la persistence dossigncs prodromiquos. K^!?! ?" *"^ ° f ^ r^ellemont, je veux parlor do la p6riode do lang^our qui pr6cdde les premidres manifoeUtions extdrioures ,ni fi!l£?"V''"'*'°''' -"^noaltre, j^roaw »u>rfo, dans la Idpre trois phases qui euccldent aux L- . J .mee : Ire la p^riode progressive; 2o la p6riode Sm^, «t'.^- '!i ^"- ' '»'»«t^»°«^«- ^ premi^ro^pout durer bion ong ftnf/ ilT f * f "«"«>« manifestations qui. toulefois. n'affectont gudre J^^^AJ^f'"^^-' * "*5?'"^^. peut durer des mois ou des ann^es ot prfis- enter dee intermissions d'accds s^yfiros et do repos relatif : la troisidmo est comparativement courte, ce qui peut vouloir dire parfois plus d'un an Mi .n„ ! f»"8'on.q"o J'aventure, et los appellations, quo jo donne, m'ont «t6 sugg^rfos par lo caracldre mfimo do la maladio ^ai n'olTro do do«r6s vraiment distmcts que oeux do son rotentissemont g6n6ral sur Torganisme. ai ou!, dan3 quelle propor> Q. 4.—" La maiadie est-elle plus frfiqnente dana un texe que dam I'aatre ? *• *— ^/.^P™ ^' plus frAiuente cbez I'hommo. La proportion n'est pas consl^ite • eilo vane cODsidirablomentsolon les temps et loe lieux ; mais il nV a pl^ iLn*"*"*''*^']" f?'^^ frequence dS:nB lo sexe mMculin est un §^ caractdres que pr6sente la malodie. Q. «.— " U It mor» fr»4UMt tmonK ecrtaln meet 7 amooK iho white, the coloured, or the bUck DODa> "lutlon? MdlD what reUtlre proportloni?" •»»v.» |ivini» A. 8.— It io hi«torloally proved that tho dinoaio attsok'" nil rano*. In Now Brnnswiok thoro hiivo boon lopow o Pronch, Hcotoh, Kngli^h and frinh doHoont, and lopars of mi»co of loprocy among tho IndinoM, althongh one of their prinoipal villages i'h locate(i in thn endemic Hootion, being oontiguoiu to the parfsh of Nigaouek. Q. •.—"la wlmt condltiun of society U tho dliei.. of moit freqnent occurrence, and what are the cir- " cnmstancei which leem to favor lis derelopment In Indirlduale, or In groiipt of indlrlduala T " Pleaie to enumerate the^e clrcumitancee under the t'ullowinK beadi :— a. The character ot " the place or district where tho ditease oiott frequently occurs In roapect of lt» btinij urban "or rural, on vho lea coast or inland, low, dami)aid malarial, orhllly and dry. ». The 9anl< "tary condition of the dwclllnRi, and of their immediate neiithbourhool. c. The babiti of "life, as to personal cleanliness or otherwise, d. The ordinary diet and iieaeral way of "Urias. «. The occupation or employmeat." A. 6 •Tho disease, in Now Brunswick, ha^ ooonrrod among tho ordinary working clauses of varied moans, none of tho fumilio.s in which it has been mot being in aflSuenco and nono in misery, all being provided with tho nocessaries (3 life. Tho circumstances which favour tho dovelopmcnt of leprosy, in indi- viduals and io groups of individuals, are ihecloseiatimauy of family lifoaad tho fffcat Buoiability of tho people. a. The places where tho malady hiw occurred are rural, with ono exception ; all these places are upon tho seo coast or in oloso proximity to it. The interior of tho countioB of Gloucester and Northumoerland is not settled. The country is undulating, generally dry, well drained, well provided with good water and not at all malarial. b, Tho sanitary conditions of tho dwellings vary, and do not differ in their variety from those of tho neighbouring parishes, counties and provinces Bimilarly situated. The dwellings of many of the affected families are good and well disposed, ot hers are not. The conditions of the immediate vicinity of the houses are very good as a rale. 0. The habits of lifo are those generally met wilh among peoplo of tho same class and following the same occupations. Tho domestic and porsonal cleanliness vary ; some arc clean and some are not. d. The diet has always been good and abandant. The way of living, so far as it affects the moral and the physio of people, is better dosoribad by the results than by fanciful or prejudiced descriptions ; the population is wollbohaved, intelligent, laborious, remarkably healthy, robust and long-live i ; they a.e not subject to any widely prevalent disease of any kind. The natantl increase of population, among these people, is exceptionally great. 4, The ordinary occupations, are farming, by far tho most important, fishing and lamberin^, and a mixture of them. All lepers have been from families con- nected with those occupations except one merchant, one the daughter of a miller and a few who belonged to the olasa ot artisans. 41.1- ■■ ltt-«ll« pint friqaentc d»oi curtaibu mck 7 pkrni " dull <|iielle propor'.lon 7" Im bUoM, In uiuUtNt oil lei noln t at B. 8.— Lhi»t(.iro dimontre quo la Iftpro Mt do loato* Ie« race*. Durm lo Nonveau- Brunuwick, il y a ou do8 Mproux d'oriKincH franoaixo, dcoMaiHO, anjjlaiw, irlandaino ot d oriKino roixle. Jo n'ai point m il mAmo d'obwrvor la maiaiiio cboi d'autrod racoH, nttondu qii'll r.'y a point on k jxiino d'individua dautroa originoH quo coIIoh que Jo vlcnn do montionner dana Ion ootnt^do Glouooator ot do NorthnrnlK>iland, A I'exception doH cauvaKOH. La frdqaenco do la malodio rio dApond pan, h men avm, do« racoa, tnais OHt on raiaon doa dauirora do propajfation amqucJH on cat HouraiH. Lo pluH grand norabre, do boaueoup, doH cas do Idpro, daiiM lo Nouvoau- BrunHwIck, ho HOtt prmluitH an »oin do la population franijiiino ot do la popu- lation d'origino mixto, la raiiladie, dopuJH bion doH anndon no s'oit moiitrto que HanH poh doiix populationn. La Idpro n'oni, devonuo ondAmique quo dans oinq looalit^H, Tracadio, Ni^aouok, Pokraoucho, Chipagan ot Caraqtiotto, oix la jmuulution (rnn^aiHo OHt aux aulros, on fommo, fonamo nouf oHt A un. La population Hauv8j,'o enl roatio juHqu'lcl compldlomont indemne, bion qu'un Q.8.- do seN priricipaux villngoH soil contigu h Nigaouek. •" D»in ((iiellp condition iocinlo U maladia ost^lle plug Wniimte et nuelloi tancej ((Hi temblent f»Toriser ton d6»floppcment indiTJiuel ou par i iont Ut oircou* ou' par Kroupei 7 VeuiUei «niini6rercciciri;»niilanceiid'apr4j lei c8l6((orleuuivaQtei : a. Le caract^re 5e« lieux, Till* Oil campagne, sur la oftle ou dann I'intfcri.ur, bas, humldei et miairaalioiiei, ou montuoax etaecB; ft L» condition saiiitaire del deinourei ot de leur Toltlna«e1mm«diat ; «. La mamire devirre, par rapport 4 la properiA ou autrement ; ./. Le rdirimB aliiuiiutaire et • autres coodltioaj hjKlfiuiquea ; r. Lej occupatioDi ot profesilons 7 " B. 6.— La inaladio, dans lo Nouvoau-Brunswick, s'ost produite au aoin do la cJasso dos travttillours, lea families atteintos n'^taient ni dans la richoHSo ni dans la mistiro, toutos avaiont lo ndcossaire. Co qui favori.so la propagation do la Idpro f'ost I'intimitd do la vio do famillo ot la grande aociubilltd dos popula- tions. a. La maladio s'oHt montr^o, A uno foulo excopti:)n prdj, A la cnrapagno. Tous loa lieux vinit^H occujiont lo littoral ou Hon voiHifiiigo immediat; I'int^riour dos comt^M do Gloucostor ot do Northumberland n out pf>int habiUS. Lo pays est oudulo ; g6ii6raIoraont aeo, bion draind, fourni do bonno oau ot nullomont miasmatiquo. 6. La condition sanitairo dos domenroa vario, nia'.o no diffdra pss, dans 804 vari6W8, do cellos doH auiios provinces, paroissea ot lieux sombia lioraent flitu>5i. Uno partio do'» domnuroM dos families atteintos 6taiont ou sont con- venablemont etablies, d'autroa 6taiont ou sont moins favorublementdispoi6o8. Los abordrt ot lo voisinago dos maisons so prd-tontont, gdnSraloment, dans do bonnes conditions. C. La manioro do vivro est coUo quo Ton rencontre d'ordinairo au soin dos popu- lations do mferae claaso ot d'occupations somblabloa. La proprote porsonnollo et domestiquo n'ost poiDt uniformo : los uns sont propros, d'autroa lo sont nioina ou pas aeevx. d, Le regime alimontairo u toujours 616 sain ot abondant. II vaut raionx jugor la mani6ro do vivro, commo pouvant influer sur le moral ot sur lo physique, par lea r^snltats que sur dos rapports inspires par lea pr^jngis ou la ftintaisio: la population dont 11 s'agit est de bonnes manrs, intolligonto, laboriouso, remarquablement saino ot robuato, do longao vie ; elle n'ost snjette k auoune maladio dominante : I'augmontation natarelle do cette population est oxcop- tionnellement oonsid^rabie. e. La principalo occupation est cello de oultivateur, viennent onauito la pSohe et I'exploitation forestidro, avec uno combinaison doa trois. Tous los Wprour appartenaient A des families ainsi occupies, k I'exoeption d'un marohand, d uno fillo do meunier et di quelques artisanc. Sevornl fftmilies were and aro roilnccd, sonio very ranch, in ciroum- slancoH, on account, of iho oxiHlonco of leprosy in thmr midst ; tbo malady wii» or iH tlio canHo of iho poverty, not tlio poverty of the m.Aahy . , J. '."'" '^""' ^"-'(0^" "i»f Iho Iiuliiitis liiivo been 11,0 only race, of those inhabiting Iht-.o Lcalilios in any nun.b.n, which buvo .•omainod, so far cxcmjit from lepro*.y ; it m well, then, (o recite the conditions of their exist-' enco a^ connected v^ith the ,,urpor. of the question I nm now answering. . The places in which tholndian. dwell boar precisely the same character as tho-o uihabitod by their neighbours, among whom tho ailment has exer- ciKcd Its ravages. Iho occi.pulioi,s of those aboi-iginos are farming, on a very small scale indeed (ishiig, hnnting, lumberingand cognate industries; thcto people are provided with tho ncces-aries of life ; tbey are wol bohnvcU intelhgcni and commonly healthy, aUhou;;h not generally long- ived ; they aro much more subjcta to scrofda and conMimption than all the Cher races, and have no great power of resistance to sickness, as a rule ; they do not iiK;rc'amongst thorasolves. Q. 7.-" What conditionB or circumstancea of life seem to accelerate or affgravato the disease when it " baa once manifested itself ia nn individual ?" uiaease wnen u A. 1— There are r.o conditions nor citcumstancos of life that scorn to accolorato or aggrav:ato per se tho disoa^o, beyond what applies to all ailments hvei', thing calculated to depress tho moral or physical forces renders the individual sick less able to resist tho ravages of this malady and therefoio, quidters its development and its fatal termination; but the Idea that the eating of a particular article of food, tho use or non- usage of certain articles of habilimeiK, can influence tho production and spread of leprosy, is, m my humble opinion, quite inadmishiblo. There are no more reasons, that I see, to attribnto the disease to, or to connect it with climate, dwellings, food or habits of life, than there is as regards small-pox syphilis, measles and other universal distempers, specifio in their character; of course crow.iing, and all which favours close contact, noeos- Bnrily multiply the risks of contagion and inioction for all specific diseases. as well as isolation is a provoi.tive against the spread of such ailments. 1 cannot take up hero tho question of common (not banal) causes possibly Doing factors in tho spontaneous elaboration of viruses, nor can I here enter into tho study of tho theory of micro-organisms in connection with specific diseases. Q. 8.-'lH HO trouvent, pour r<5^ondro A la quoation en co qoles regard" Lo liou d bab>tat.on do ce8 aborife/ono8 preBento al,Holumont loJ m6mos carac tdroB qu« lo rc«to de la rontroo. Cch gonH f.mt uno potito cullmo ctZit eurtout cha«.eur., p6chour« ot bftchorons il. oxor^ont en.o.o d'au tro/, otUcs nduBtnos do vannrno ot do m6Ki..ono ; il. no manqnent vo\utdVi7cZ ea.re ; i1h sont pa.s.blo. ot rang?H, intolligonts, generaiomont bion i^ rtuuN pluH sHjcts a la Hcrofulo ct a la consomption quo Ioh nutrcs races • ils roMstcft malauxmalad.os graves et n'augmontLt point on nomb^o^cu s dom /ro ' A pen doxcoptions prd. M>„t mi.6rabloH, info.ieurcs aux pins mauva's.^ dcmcuroH dos blanc. o.s plus pauvre.. En u,. mot, les mioL dW ILux aont dans d.» condi ions ogales ot la plupart dans de« conditio^is in 'rTeuies A col 08 do la claKHo la moins A l'ai>e de« autr.-s races. La cculo rai.on ouo je pu,.«e a..,gnor a rimmuni.- ^.„n,pl.-„., do„t ils ont joui" o. I'ab" „ o^do relat,o>,8 fam, litres avoc le^ ,os naiionuli to., avec lo.quol le. cLo" dant 1^8 son on tros bons tormeH: ..,„ciu. ici .Wouio avec les «ionH et^c'oat la population fran^aibo dont les rappo. t« «ociuux «ont les plusbtimel ^•'^•"•^°on°a^:;aS:-P:;l"L1^'"r ''■''■"'" °^1^ ..•iroonHtancoe qui «emblont nccelerer on aggraver do soi, la lo|.ro, on dehors do co qui e«t eommun A touted los maladicH. Tout co qui pout affaiblir lo moral ou lo phy«i. "o to d A .xmra lemalade mourn capable do ,««iBter aux ravages du maU preStrcons/ qnemment, la terminai^on fatalo; mais I'idoo qae Tusago LTaStontion dun aliment quolconque, d'un vetoment quel^nquo pouveut avo r une Ldmi^:ib"' 'i|P -v'r,'?" r '",P'-°P''««'-'l. 'ie '« ?dpre^Hom£ab:olunrn? inaaraiceiblo. ll n y a pas plus de raieon, selon moi, do rattachcr la lanro anr Influences descljmats, dos habitations, dc aliment , dc. habitX S n^en ex,sto A regard de lu variolo. de la .yphili.. do la rou'goolo ct a u re's maladies ppdc.fiq.cs iin.vorsellos. On comprond que I'onco.Uremont e 10^100 oni peut nmlt.pher le. contact., augmonto los dangers de comn?u, icatLn do toulg les mulad.es do co genre, do mdme quo la .^uestration s'o p .oso A la nrona que peuytnt jonar 1,.- causes communes (non banales) dans I'^iaborAtinn 12 I know many inatances where one member only of a family has been aflfected with leprosy, while all the other members remained free from any trace ot it. In this connection, it is not idle talk to remark that the mere fact of the appearance of several cases of a disease in one family is, primd facie no more suggestive of hereditary than of contagious transmission. The Bignificance of the occurrence is a matter of medical and philosophical criticism, which has to consider the character of the malady, the order of time, and the circumstances and surroundings of each case. Q. 9.— "Have you reason to believe that leprosv U in any way dependent on or connected with " Byphilia, yaws, or any other disease?' A. 9.— Leprosy is certainly neither dependent on nor connected with syphilis. It cannot be dependent on any other malady, it being a specific disease, quit© distinct, therefore, from all other distempers. A leper may become syphilitic as ho may become phthisical ; he may catch small-pox as he may catch the itch ; he may die fi-om any intercurrent ailment, as he may bo killed by accident ; equally, in such and other similar cases, the event is not of leprosy, hut in addition to it. There never was any trace of syphilitic affection discovered in any of the lepers in New Brunswick; small-pox never happened among them; the itch made its appearance in the Lazaretto on few occasion'). Only two lepers are known to have died from inter- current discatses : one, a girl, from phihisis ; the other, a man, from pleurisy. Of course, the invasion of an accompanying chronic ailment may be anterior or posterior to the development of leprosy in the individual. In the case alluded to, of the phthisical girl, phthisis showed itself in the course of leprosy, and exercised over the latter affection a decided revulsive and depurative action. Q. 10.— " were viiere ui^cri*nuun wm* » discnarge i «. - .^™- — ~.~«~ " of contagious communication which you have seen yourself. " be transmissible by sexual Intercourse ? " A. 10.— I am aware of many instances of the disease appearing to be contagious, in the ordinary sense of that term; 1 mean instances in which heredity cannot bo invoked and in which contagion is the only cause capable to reasonably account for the propagation of the maladv. The typical character of leprosy, the category to which it consequently belongs in the nosological table, its general history and what I have ascertained in New Brunswick leave no doubt in my mind about the contagiousness of the disease. I firmly behevo that it is communicable from the diseased to the healthy. I do not think, from what I have observed, that prosimity, no matter how close, nor mere touch, can convey the contagion. In my opinion, there must bo an adequate contact of some kind, mediate or immediate, of course, with an individual susceptible of contracting the malady, and, at the time, so circumstanced as to be ill ■ situation to receive it. I hold contagion as the cause of the pro- pagation of the disease ; and in so saying I do not lose sight of the fact of the occasional spontaneous production of leprosy ; importation, of coursei, means contagious spreading into one country, when it extends beyond immigrants sick, and their descendants. ., , , . , .,.,.* » There is a case, the facta of which are established beyond possibility ot cavil, in which the disease appears to me, as well as it did to those who wiU nessed it, to have been produced by the absorption of liquid matter discharged from the body of a woman who had died in a cachectic state from leprosy. At the funeral of that woman the body was carried (according to a then long-standing custom, which has boon since abandoned on account of what. 18 Jo connais beanooup do cas dann Icsanols la mala Ho n'a sdvi qne sur an membro d uno famulo, tons los autros domourant intact^. Sar oo suiot. il n 68t pas inntilo do romarqoor quo lo simple fait do la pr6son(>o do plusioars cas dans niio famillo n'aatoriRO pas pins h conoluro iV fh^iddit^ qn'A la con- tagioB i 1 appreciation do revSnoment est raatidre do critiqne philo8ophiqne et mWicalo, dans ! application do laqnelle il fant tonir corapto do I'ordro da temps et do toutes les ciiconBtancof. qui ont pr6c6d6 ct accompagnd ohacjae ^- '•-■' X%r4/adtrot»'VXe1^ da plaa o. R. 9.— La lepre n'a coitaincraent rion do oommun avecla syphilis ; ello no pout ddpondre d aucune autre maladio 6tant mo afToction sp^cifique, con-s^quom. meiit distmcto. Un 16proux poutdevenirsyphilitiqno corarao il pout dovonir phtisiquo, il pout contractor la variolo comme il peut attrapor la galo, il nout mourn- d une maladio inte.uu.routo comme il peut perir par acddont: Sans toas cos cas evdnoment n'ost pus do la Idpre, main fui est ajoald. Jamais on nadecouyortdosymptomes hyphilitiques choz Ics l^preix du Nouvoaa- IJrunswick ; a variofe non phi., no s'ost jamais montrdo choz oux : la galo a m introduite, en quelqucs occasions, daus lo lazaret. On no connalt quo aeux cas de mort caus6o par dos maladies intercut rentes ; uno jeuuo fillo est raorte oo phtisu. un horamo est mort do plour^sie. Evideraraont, I'invasion d une affodion chroniquo peut etre antdrreuro ou pjsteriouro A l'uppunt!on do la lopre Chez un ind.yidu. Da.m le cas cltd do consomplion intorcur- S mar ulT"' * "^'"''^ *""" '^^""^ ""° '"'''°" >6v-ulsive ot ddpurativo Q. 10.-" Ave^-voua rencontre dea cas of. la maladle a sembW contaRieuso, dans le gens ordinairo da . u i'„ *,"-^-''r^ transra.ae par contact direct on par proximit6. a. Bi oui, rquelle p6riod2 dftcharRe ? A. VeuiUez raconter les cas de tranamisaion par ooatagion doat voui avez 6t4 vou8.m«me t6mom ? c. La maladie semble-t-elle traaamiaaible par^'union Jxuelle ? " B. 10.— Jo connais boancoup de cas dans lesquels la maladio parait avoir eto trans- miso par contagion ; J3 voux dire des cas qui no sauraient relever do I'hdre- dit^ ot dans lesquels la seulo cause capable do rondro raisonnablomontoorapto do 1 apparition do a maladio est la contagion. Lo oaractdro typinuo de la Jdpre, lo rang qu olle occupe consdquemment dans lo cadre nosologiquo. son histoiro gdn^ralo et ce que j'ai obserf^ au Nouveau-Brunswick no mo laissent aucun doute sur le fait do la comraunicabilitd de eetto maladio : Je crois lermemont qu olle ost contagiouso. Jo no ponso pas, d'aprdi ca quo j'ai observd, qu olio puisse se transmettre par proximite ou attouchoraent ; seloa moi, il faut qu il y ait contact virulent, m6diat ou imra6diat, nSce^iiromont aveo uno personne apto a recovoir la contagion et prdsentant, au moment da contact, les dispositions ndcessaires A son introduction dans lo systome Bn asBignant la contagion pour cause de la propagation do la Idpro, je no nords pas de vue la possibility de sa production spontando. Las mots importation de la I6pre, au aein d une population saine, voulont nSoesjairemont dire pr»na- gatioii par contagion, dans lo pays do reception, quand la maladie s'dtond A a autros qu aux immigrants malades et a lours descendants. II y a un fait parfaitement 6tabli, qui constitue pour moi et pour toas ceux qui en ont eu connaissanoe, un cas Evident de transmission do la Idpre par ahsorption de la matidre liquido 6ohapp4e da oadavre d'uno femmo morto de la maladie 4 I'dtat caohoctique. Aux fundrailios de oetto femmo (.a apros un ancien usage depuis abandonnd A caaso do Taocident dont il est qnestion) le corps dtait porte sur loj dpaales de quatre robustes jeanos hommes. La joarn6e 6tait chaude : tent d'un ooap, une matidro liquido se mit A smnter A travers un des joints da oorcueil, humectant I'^paale d'an des portears. L humidity oombin4eaveo la ohalear et k forte prossion de I'angla 14 I am now reciting) on the Bhouldors of four strong young men. The day was hoi, and, on a sudden, liquid matter began to oose out through a joint of the coflSn, wetting the shoulder ot one of the carriers. The wet, com- bined with the heat atid the pressure of the sharp edge of the coffin, pro- duced an abrasion of the skin of the young man. The contact of the liquid matter with the abraded surface lasted a part of the time of the procession and the whole length of the service, as it was only on his return nome that the young man washed his sore shoulder and changed his clothing. Some months after that man, whose health had always been robust, began to feel nnwell ; in a short time the symptoms of leprosy made their appearance, and he died of the disease eleven vcars after the oocurrcnce. There had never been any case of leprosy in his family, whose ancestral genealogy is traced for several generations back; in fact, the disease was not yet known as leprosy, being of recent appearance in the locality and among these peoDle i he was the fourth case in that place, the three others being the woman spoken of, the husband and the sister of that woman, in the ancestry of whom there had never been, neither, any trace of the disease ; the fifth case in that locality was the sister of that young man. The woman's hus- band and sister had the disease a few years before her death, and the young man's sister a few years after the commencement of the disease in her brother. The woman spoken of had ulcerations, with abundant discharge, at the time of her death. This would be a case of the well-known survivance or pos- thumous persistency of the malignity of virulent matter. I have not seen, myself, any case of contagious communication, if by that is meant the eye-witnessing of the application of the contaglum, whatever that may be, followed by the development of the disease. I have Mver tried to inoculate or otherwise produce leprosy. The contagious chai-acter of a disease, especially when the disease is of slow develop- ment and of gieat lastingness, can bo and must be proved, according to my ideas, by the study of the intimate nature of the ailment, of its appear- ance, spread and disappearance, within certain areas and in relation to groups of population. It is the principle of circumstancial evidence applied to etiology, a kind of evidence which, in such matters, I, for one, consider much surer than the testimony of few or several witnesses, who possibly may delude themselves or be deluded. The negative proofs are of some value only when general in character, and, at the same time, not contradicted by positive facts. This aegative evidence has been invoked in the case of the most evidently contagious diseases. The way in which leprosy disappeared ft-om countries where it formerly prevailed, the common consensus of nations, as proved by their legislation and the moans taken by Church and State to eradicate the disease, are witnesses to the oontagionsness of leprosy ; what I have ascertained and observed myself, in New Brunswick, is in full confirmation of the truth of that belief. It cannot be expected to have such a subject treated in the short answers to an interrogatory. I intend to do %o in a work, the materials of which I have been collecting for many years, if I am spared to complete my investigations and to finish the labonr now far advanced. . One husband of a leprous woman and one wife of a leprous husband have, so fto, had the disease in New Brunswick. The sexual organs, in both sexes, •le apt to show several of the mamfesUtions of leprosy ; the logical infer- ence IB, that if the malady can be communicated by contact or inoculation, such a contact as produced in sexual intercourse, may give efBect to the transmissibility of the afiection ; provided the local let- ions of the diseased are suoh as to produce the transmission, and the healthy subject is suscep- tible of ac^ttii^iiig tiie malady. 15 *i aigo dn cercuoil prodQisiront uno excoriation d I'^paule du jenne hommo. La iurlaco dinudSo rosta on contact avoo la raatidre liqaido pendant nno* parti© du temps de la prooeasion du cortdge ot tout lo temps du service iandbro i car ce ne fut qu'4 son retour k la raaison que lo jeune hommo lava •on ^paule blese^a et changea sea habits. QnelqnoH mois aprds, co jeuno homme, qui jusque Ik avait toujoura joui d'une santfi parfaito, commenca a M aentir makde et, on peu de temps, so d6velopporont en Ini lea premiers aymptomos do la Idpro, dont il mourot onze ana api-^ rfiv^nement quo je viena do raconter, '' Las anc^trea do co jeuno homme, dont la gfinfialogie est connuo, n'ont jttaaia 6t6 aiyeU A la lipre ; de fait, la maladie n'csistait dans I'endroit et parmi la population dont il B'agit.quodopuisquolques ann^es, et n'avait paa encore 6ii dingnostiqu^o sur place ; lo jenne homrao fiu lo quatrifirae aiteint: lea troia premiers flirent la femmedont leafandraillos aontdovenueB si triato- ment remarquablea, le marl et la scour de cotto femmo; lea ancStres doa deux sceura et coux du mari de la premiore victimo n'ont jamais connu la Wpre, anoun membre do toutes cea ftimilles n'on avait ^t^ auparavant frapp^ La cinquiSme peraonne qui fut attaqufie par la maladio en ce lieu 6tait la eoBur du joune homme en question. Lea symptdmes de la Idpro ao firont voir Chez le mari et la sceur de la difnuto quolqnos annSoa avant son ddods ohea la aoour du jeuno homme quelquoa anndea aprds le d^voloppoment a« la maladio chez celni-ci. a. La maladio de la dfifunto on atait aax dornidros p^riodes de la cachexiej ily avait uicirationa avtc d'abondiintes decharges. On connaft r«xiatence de la poraiatance posthumo doa virus. 6, Je n'ai point obaorv^ moi-m8mo do fait do contagion, si par cola on eotend avoir vu do aea yeux I'application du contagium, quel que soit cet a^pnt, auivi du divelopperaent do la maladio; jo n'ai jamais, commo do jaiflOD, eeaay^ d'inoculor ou de produiro autremont la Idpro. Le caraolore OOBtagieux d'une maladie, surtout d'une maladio lento et de longue dur^e, Kut et doit se d6monlrer selon moi, par I'^tude do la nature intime do ffection, par I'hiBtoire de aon apparition, de aa propagation et do sa diapa- rition, dana dea circonacriptiona dfifinioa et par rapport & des groupea parti- ouliera do population. C'eat lo principo de la preuvo ciroonstanoielle appli- qa4e & I'itiologie, genre de preuve quo je conaiddre, avec beancoup d'autree, «ooantrio«' whoio these hospiUlu are ortUib- lisiitd m t that tlio history of cuboh, &a iniwf " of nudh hoipitalB, ix not a lull history of iboeo caae^, and it is for this rouHoi. that iho procedinj} tables are tnnde to Uiko in (ho lepom at largo an well «« the lepers Inhabiting Iho The 'fiauroH of columns 11, 12 and 13, in table II., may bo somowhat defective, not in toUl numbers, but in tl.o distribution of the <><««««« appertaininif to each particular year, on ao.coni.t of the extreme difficulty to asoortaia with Homo precision the exact time ot the b.'guininK ot the diBeane. They may also be deficient in so far as there mipht posHibly exist one or two cases of lopro.sy not yot dotootod. But «uch littfo doieots. if there are snch defects, cannot materially influence the grand resultH, nor can they at all alter the higniflcance of thene tables: thobro«J fucts would reraam, with their distinctive features, in spite of the greatest possible defioiency ot '""""no leper, in New Ilrunswiok, ever entered the Lazaretto on the first roar of the outbreak of the diseaflo ; very few, if any, on the second year ot the existence of the malady ; several on the third year ; many on the fourth, several on the fifth, and some at a still more advanced period. The patient hereinbefore mentioned, who has now been at least forty-six years a leper, expended only nine years of that time in that institution, on two distant oooasionHi she had been about six years sick when the Lazaretto was esUb- '" *The two tables concern altogothor 68 putionts, 32 men and 2G women; of these 68 cases, .16 are anterior lo the first of January 1875, and 22 are posterior to that date. The tables show that the disease has undergone, on the whole, a considerable diminition j notwitl.^ landing the fact that the mor- tality has been, comparatively as well as ao,iolutoly, much less during the last^ve years than during the first five years of the decenniad. Another irratifyinK fact revealed by these tables, a fact which I consider connocted with the decrease of the malady in the relation of cause and effect, is that a much areater proportion of the leper population existing at a given moment has Eeen, for eome years past, segregated in the Lazaretto than was formerly the Q. W.— " A. 16^ ibscrTfd from the hygienic, the dietetic, or the "•«cmai «»«»» leprosy erer undergo ■ epOBtaneoua euro ? and if lo, at what lUa rou awsre what proporUon of the leutoua poor, treated at the pubfl. What reiult. have you obscrred from the hygienic, the dietetic, or the medicinal treatment " oJ the dlseaie ? Doei leprosy erer undergo a ep ' ' of the diseaie 7 A re you aw«re what proporUon of the lu j " expenN In New Brunawick, recoTsr wholly or partitiliy ( Ti.o results I have observed from good hygienic and diet^t'e tre-t^ge"* »" tiiat the influence of the disease is lessoned and life is prolonged. Ih's hM been rendered verj apparent at the Lazaretto, especially since t^ie year 1880, that the buildings wore made more ample and comforUble, other mprovft. ments were provided for, and the entire ni»»af ""«"* / ^^fj'*'^^^' .J^^ transferred to the care of the Sisters, ttoxr. ho lormer direction of a .unc- tionary who was called keepewsook. 'iaose beneficial results t .; , sanitary meiwures are, nevertheless, only a respite of a few years The various and Multiplied attempt* made at different times, in .,^ Brunswick, by medical men, or uuJer medical guidance, to onre the diseaw, ba^e all failed, as have also failed several empiric methods and vaunted *" '"wdial attendance to common ftinctional disorders, palliaUve treat- m<.nv '.ho painful manifestations of leprosy, and a^if^t'^". ';'^„^« "f X, ^v , -. , .bough no cure, are, nevertheless, highly beneficial, and are ..U; ^^x.ted w »t the mw BrunswickLazaretto. aoDBts 1V-. .aii a spontaneous cure of leprosy ; nor has Oioro been u ifl^vt Brunswic'.' ^here all lepers have died of the disease II D i)«t pan inutile do i^jiAtor qtie rhiotoriqae den iaesrata n'o«t pat uno hUtoiru coraplAtoda la Idpro pour fad ()«yu 06 ce* institutions »o i 'ntontront, etquo lo narr6 doit can, |X)ur U period, fo i<<5jour diknit ceHhJpitau.., u o«l pan nn compte-rondu complot 6 duiiN la troi»idmo anndo, beaaooup dana la quatridmo, plmieun* dana la t nqiiiOmo et d'autroH A uno pdriode eneoro pluH avunc(i«. La malado qui ol jnt A oa quarante-aixidmo anode do maladie n'a pas^6 qu'environ nouf an.. daoB lo laaaret, en deux occ*«ion8 bien diBtantca I'uno do rantro; il y avail -ix ana qn'elle itait affoctie, quand lo losarot a M dwbli. Lea doux tableaux concornont 68 Idpreox, 33 hommea 012*1 foi mee: de ces 58 ca?, 36 Bont antdricurg uu proniior Janvier 1875 ot 22 ont vi com- moncer la maladio dopuia cette date. La diminution du nombro dee mu ^doa eet trds marquee, mnlgr* quo lo ohiffro do la mortality ait M abholumoi relativemont boftuooup miiJUB consid6rablo pendant la aoconde moitid d dicado quo pendant la premidro. Un fuit conaolant qui rpSBort ruhmI d. constatation dlablio par cch chiffres, fait qui bo relio A la diminution d( maladie dana lo rapport do cause A effot, c ost qu'aujonrd'hui on compto j, do maladea en doLora du lasaret comparativemeDt A oc qui avail auparava.it lieu. ot la la la u * 9, , 'S?' '". '*•""»'« que ^o"» »»e» obierTja da trallement hjgienique et midieal de U •• ?'•■?,'• *li V%?"!i? •''™Bn'»'f* <1" m»l«de« ? La lApre ptuftrit-olle sponUnimen t ? Si oui, » quelle ptrlode 7 OonnaiMez-Toui la proportioo dca 16preux mainteDMS par I'Btat aul " guirlMent entidrement ou partiellemenl, daoa le Nouveeu-Brunjwlck?" ^.W" — 1*6 r^Bultats que j'ai obeorvda d'un bon regime alinfiontaire et de condi- tions hygidniquos favorables wont uno tolerance plua grando de la maladio et uno prolongation de la vio des malades. Cool a'est fait voir d'uno manidro marqu^ an lazaret, surtout depuia 1880, quo Ton a ajoutA auz Mificop, ain61ior6 lea conditions sanitairoB et passfi I'entidro administration SDX mains des Soenrs, des mains d'un lonctionnaire qu'on appelait gardiou- oniBinier. Copendaut, ces risultats d'un bon regime nosont, aa mieux aller, qu'nn r^pii de quelqnes anodes. Lee tentativoe nombreuses nutant que variees do traitement mddical, I empiriqnes et radministration de remddes vantdi. Le traitement des ddeordres fonctionnels, les moyens pallintifs et Ifls bona soinp, sans gudrir la Idpre, ont copondant, cela va sans dire, d'ex- cellents eflFetH, et rien de cela n'est ndgligd an lazaret du Nouvean-Brnna- wiok. Je n'ai jamais obeervA de oaa de gndrison apontande ; il ne s'en est pas jMrsdntt, dans le Nonveau-firanswick, oil tona lea Mprenx dteddds sont morts who aro not still alive, with the exception of one death froca intercurrent phthisis and one from interoarrent pleurisy. There have been discharges, eepocially of children, from the Liziretto, of several who had been received on more suspicion or unconfiimod diagnosis, and many yoarsajjoofa lew loners who were reported cured, but who have all come back with the disease. One of those, now in the LazH-etto, is the woman I have before mentioned as having had the disease for at least forty-six years. This case is so very remarkable in many respects that 1 think it well to recite it. This woman was born in 1813, and was married in 1832. She was strong and healthy, and the mother of two children, when the disease made its first appearance in her system— about 1838. She nevertheless continued to cohabit with her husband, to attend to her household, to enjoy fair health, and had throe children after the outbreak of the disease ; the last of those, the fifth, 80 far, was at the broait, nursal by thi mother, when both were forced to enter the Lazaretto, on its opening in 1841. During her sojourn in this institution her general health was good, but the malaJ^' male loottl progress, at first fearfully mutilating her hands and feet, luen she entered a period of quasi suspense, during which, after having been sub- mitted to a medical treatment, she was doolared cured, and discharged in 1819. Boiug returned to hor husband she got a child in 1850, and another, the seventh, in 1854. She lived at home with her husband, who died in 1874, and thon with her son till 1880. Then she entered the Lnzarotto for the second time. During the thirty-one years that elapsed between her exit from and her return to the Lazaretto, she was an enigma for all her relations and neighbours; soma said she was cured, Bome said she was not; at times she appeared well, at other times she did not look so well. I visited her at home on several distant occasions, and thw is what 1 have b^en able to observe and gather:— A very slow, but atili apparent, progress of the morbid process in the appendages of her eyes; pains in thebjnes, which she attributed to rheumatism. I suocoedad in getting, in spite of hor unwillingness to account for herself, some inf irmation ot the presence of anrosthesia fixed in her mutilalol hanis and foet, and undergoing changes of localisation in other parts of herbjly; thosj must have been followed by other occasional outward manifestations; she would not, howovoi. admit any such thing. I felt sure that the malady was still in Uor,, and 'old the Sisters that, if she did not die from some other cause before, ehe was sure to come again in the Lazaretto, whore she is now, yet strong enough for hor sovontytwo years of uge, but with chardcteristio anioithoaia, bone-achins and the occasional development ofsmall leprous ulcers. _ The husband was, to his last days, perfectly free from any sign of^ lenrosv. Of her children, graadchildron and groat grandchildren, only ono his boin the victim of the malady-her last child, a girl, who died a few days ago at the Lazaretto. That girl was attacked by the disease in 1863, in her ninth year of ago, and is the patient I have mentioned in whom the ailment has lasted twenty-two years. The father "''d 'no'-hor of the o d woman, as well as her ancestors, were all free f;rom the disease to their deaths ; but a sister-in-law, with whom she was in intimate relation, died of leprosy; and two of her younger brothers, also, fell victims of the malady; The case of that woman proves that leprosy may attack a person free from any hereditary taint; it proves that fecundity of women can be pre- served even when the malady had lasted for a long time, although it is not so in every case ; it proves that cohabitation may not communioato the disease, although it may in certain oases; it proves that chi dren are born healthy, notwithstanding the existence of leprosy in parents, al^l^o^g^ t^«y ""^ acquire it. As regards the question of hereditary and contagions ft-ansmiB- Bion. this wmarkaijle case offers an interesting 8ub)ect of Btudy, which I intend to take up, with several other oases, in my projectodiwork oa Icprcsy. 25 de la lipre, sauf deux cas do mort im malaUios intorcunorito« un do dnrrnni""' <"•"'" SuonHOim est colm do la fommo, .lo,U la maladio "jS CoUo fommo uaquit on 1813, ot ho iQaria on 1832 ; olio iouitisait .I'l..,.. r dirt;!' ss 'tr'"":^' '^'"^ "i-^f'' ^''^-' '^^ -"^r^'^n'r ou tllo, vol,- 1838. i-.ilo contiuua ii ojliabUor a»«G non maii a louir sii ma,.on ot A jouir d'uuo Banto gdneralo .ati^fai.anlo ; tro Lon^u 1 viuront r«ff^n?r '■""/?"'' '°' '" '^°'''"°'- "^"'^ -~' '" ra''"^*^"" lor.-,ciuo la m^o ot Colndtl wT"'''/']?^''-^'''''' ^''"^" "«"«'-'^ ■''" '"=^i"^in^ on (10 tcniblos mutilations, apro.-* quoi lo mal .sorubla ontror dan.i uno ..e nodo do quasi suspoDsion, qui, uyant 6t^ :...o,apiyn6o d'ua Ualie mout a 6J cal HOn septiomo, on 1854 : son man 6tant won on 187J, olio contiuua 1 vivra inontH, olio fut uno en.grao pour tous hoh parents ot voisiDH ; los uns dis'iiont 1 l^.il -.^'""i'-' '^ ''""■'' ;!'«»'«"*. -ell" o.t onooro malado : p. f' solle Fa^^^ rl'^n'^'" '""/•'■' ^ 'r^''*^^'''^ '-•'•' •^'-^'^bl-il un pun inc.ia\uo.loo. Je vli CO „,K pr'" ^'''" «'i«f=*e^''^''p intorvallo. do tomps choz o le, o? void CO quo J ai pii npprondro et obwver :— Ua pro.rroi tros lont mai, dernier eymptome lui ^tait «rLhe,t di;Vtl\>;iiLti ^ , '^^rmoUai? gouHo«daQosthesiodova.outetre parfoi. suivios d'autro.. raunifistation *• S maladio"!tT "' '•"'" '^'^°"'-«-, -^'e'-^i^ cortain do la prison 1 ^1010 parauti^caaso,ollo6ta,tdo.tin^eamouriraulazarot, o,i olio ost m'into- nant, forto oncoro pour 8o« Hoixanlo-douiio ann ; rauis airoctoo d'anoTtho* o tourmont,^o parfoiH do doulour. o^t^ocopo. ot .oUi.o, do tonip r torZ' aux evolutions do potits ulcdres leprouxf ' ^ ' Lo mari do cetto fommo est restd oxompc do touto attaquo do la lanra jusqu-aHOBdornior. momonts (1874); auoun do so. onfantTdoses S S?« ?'^i 1?°°'^?'^^ '""V': 'e^ effets do la maladio en 1863, a I'd^o do Zf auH c est la malade choz qui lo mal a dur6 viugUdoux an«. Lo poio la md -o et Io8 ancetro. do la vieille fommo n'or'. jamais ou la Idpro ; ma "s oilo^lme ay^cu dans l-intimitA d-uno boUe^ceur I^prouso; deux^ do sr frSel P^ jeunes qu'elle, sent morte victimes de la maladie. ' ^ Co oas demontro— quo la maladio pout so d^voloppor on dehors do I'h6r6. dit6,-quo la feoondita peut se maintonlr longtemps malgnS la ijo bion q^ oe no bo.t pas tomours le oa8,-quo la cohabitation n'ost pas touSrsSe^da d^vdoppomont do la maladie ^ez le conjoint sain, bien que Tela aS- JulrSatSir'^Co^or'"' ^' parents Ifipreux', bien \u'ns piwV ?ur leVnurt nnl H-h^i^^^- T"'"1"'''''"' °«f™ «'' inWrossant sujet d'eludo, (•ur 108 queations d'h6r6dite et de o.ontjK/iAn Ho lo ia : * J? , ..... ixiuuiuuQuio uiiro uu inierossi |.ur los questions d'h6r6dite et de contagion de ia Idpro . anaijser en uetaii avoo d'autros oas, dans I'ouvrage que jo Je ma prono/ i r *. 4. — " EUe cat beaucoup plus fr^quonto chcz I'hommo. Q. 5.— " Est-elle plus freqnento dans certaines races? parmllcs Wanes, les muldtres oules aoirs? Bt dans queue proportion 1 ' ' B> 6- — Prdsentomont ello est limil^e aux porsoones d'origine franjniso. Pr6c6doni- ment plusieurs individus d'antros nationalit^s en ont 6l6 affect6s, sans donte par contagion. Q. 8.—" Dans quelle condition sooiale la maladio est-ello plus fr6quent6 et quellos lont les circonstances qui semblent favoriacr son d6veIoppcr.ient indiriduel ou par gioupea?— Veuillez 6num6rer R 6. "autros conditions hygi6niques.:—«. Les occupatious ot professions ? -Pendant mon f^jour A Tracadie, j'ai observe quo la maladio apparalt soalemont parmi les plus pauvrcs. Dans un de mes rapports, je disais quo — " ft mosure de I'amfilioration des conditions do la population, produisant un regime alimentaire plus nourissant, la maladie finirait par disparaitre." La pau- vrete, de aoi, ne saurait prcduiro la Idpre ; raais ft cause de son influence d^primante, elle somblo favoriser le dfivoloppement de la maladio choz ceux 2"* y sont MrMtairement midisposis. Je concours entidrement dans I'opinion du Dr Tach6, quand il dit : — " Ce qui favorise la propagation do la lopre o'est I'intimitddo la viede famille et la grande sooiabilit6 des populations. a. Tracadie est un liou voisin de la mer. b. La population est 6tablie sur des terres, cons^quemmcnt .les demeures sont Isoldes et salobres. C. Les habitudes sont bonnes. Les gens sont religieux et se marient jeunns. 4l, II y a maintonant abondance d'aliments sains dans I'endroit. Les paresseux eont natarellement lee pins paavres et lour regime est rarement sain. J'ai frequently noticed that when such persons are ill from serious disease thejr readily succumb. t. Fishing and farming, Q 7._" What coaditioni or olrcumiUnoei of Ilfo aeem to aecelente or aggraratc the dlseaie when 11 " " has onco manlfeitcd it*elf in aa indWldual 1 " A. 7.— I beg to refer to Dr. Tachd'u reply to this question, inasmuch as mine would necosearily be similar to it. Q 8— "Doeg the diaeaso aMiear often to bo hereditary? Havn you known instance) where oa« "member only of a family has been affected while alt the other memb9ri remained free from "any trace of it?" A. 8.— I am unable to adduce proofs of the hereditary nature of the disease, but hold that the thoorioa of hereditary transmission and contagion are not incompatible. The disoafeo frequently skipn over a generation. I have known many instances where one member only of a family waa affected. Q, 9.—" Hayeyoa reason to believe that leprosy is In any way dependent on or connected with ayphilit, "yaws, or any other disease ?" A. 9. — ^I have no reason to suspect that leprosy in any way depends on, or ia con- neuled with any other disease — it is a diaeaso sui generis. I,, 10.— " Haye you met with instances of the disease appearing to he ooataglous, In the ordinary "sense of that term, i.e., communicated to healthy parsons by direct <; intact with or close " proximity to diauased persons? a. If so, iu what stag) was th) milady in thn diseased "person? Were there ulcerations with a discharge? 6. Please to describe briefly the c.ise " or cases of contagious communication whicli you have seen yourself? c. Does iht :f'«Ba88 " seem to be transmissible by sexual intercourse?" A. 10. — I have not mot with instances of the diaeaso of which I could affirm that they had boon communicated by diseased persons ; but I am convinced that leprosy is contagious, although not to the extent of other contagious diseases. The people of the leprous district intermarry very freely, and it is difficult to exclude hereditary taint. But I am confident that in former years persons free from hereditary taint contracted the disease, while living in Tracadie. Q, ii,_<' Are persons affected with leprosy permitted In New E unswlok to oommanloate freely with <• the rest of the community 7 or is there any restriction imposed, or segregation enforced, ia M respect of them ?" j^ 11.— It is not at all times easy to secure prompt removal of affected persons to the lazaretto, but once admitted, segregation is complete and permanent. Q. ia._" What public provision is made for the receotion and treatment of the leprous poor ? Ar» . " they admitted into the general hospitals? or are there separate infirmaries or asylums " provided for them ? Please to describe the structural and sanitary cooditiona of such " buildings and the arrangements made for the medical and hygienic treatment of the siok ia " them." A. 12.— To Dr. TachS's reply to this question I would refer for full particulars, which it ia unnecesBary to repeat. O. 13.—" Can yon state the number of leprous persons maintained at the pnbiie expense iu Ne'T "Brans wick 7" A. 13.— The number at the close of 1884 was twenty-two. souvoDt now que cm poT9onne« snocombont promptemonJ, auz maladie* f^ricnseB qni leg atteignont. ' ramauie* e. La pftohe ot la cultaro, R. l~Je domando pormi8«ion do renvoyer A la r^ponso da Dr Tach^, attonda qae ma r^ponao ne saurait manqiior d'etre analogue H la sionno. ^ Q. 8,-"Lam.l»dl« parallHillc h«r6dlUlr» 7 Oonn«lM*z.TOQ. deg fiiu de la nr6i.n<>« d. U Un.- Che. un membr. d'une f.millo dont toa. I., aatre, membrwlont demSinl.ct, ? ' '^" K. 8.— Jo DO Buis pa« capable de donnor do8 preuvos du caractdre hSrWiuiro do la maladie, mam je tions quo los theories de la transmission par hiridiU H nor gSSn"*' """^ ^'°' incompatiblefl. ^a malaaio saute souTonl uao Jo connais boancoun do faits de la pronenoe de la raaladie Bouloment ohoz un membro d'ano famillo. "uuioiutui, Q. 9.-Avez.vou.rai.oa.d. """^^.q"' l»,I*P;-^,|l*.^nd ea quolqu, f„on de la .ypUili., da plan oa d'autres tnaladies, on qii' R. 9.— Je n'ai auoune raison do soupgonnor qae la Idpre dipendo, en quolquofaconaue ce HOit, de quelqu'autre maladie :— o'est nno affection swt gmeris. ^ ^ ^ "*■"" »Zr°."i.1' »!S?"*.''" "• °^ '• "*'»'"• » »«'°*''* C'"J«*Ki<>'"e, daae le .ens ordinaire da TJ'/?'*"*^"?"? t™°>"n.'8o par contact direct ou par proi mit6?-a Hi oui i nuell. p6rlode la maladie en itait-elle chez la peraoane affectie f HstTce qu'il y aralt de3^ic«! R. 10.— Jon'aipointroncontrSdocasqaimepormotted'afflrmer quo la maladie a 6t6commnniqu6epardosmalade8; mais jo suis convaincu que la Idoro eat contagionse, bien qu olio no lo soit pas aa mSmo dogr* quo d'autres maladies contagieneee. Lob gens dos localit^s of, bo rencontre la Idpro B'unisBont par manage et .1 est difficile d'oxclnre I'inflaonco h6r6ditaire; mais io n'ai nas do donto quo, anno dpoquo ant^riouro, des icdividus exempts de toute tointe h6r6ditaire ont contracts la maladie, pendant lour s^jour A Tracadie. Q. II.—' ■" ^^^^^^li^^lllh NouTeRo-Branawick, am personneg affect6eg de 16pre do communiauer <'5&?ationM^:rdr?'''*" "'"° "^''"" ' "*" ^«""<=«'"» <" Pr.«q"3"fl R. 11.— II n'est pas toujours facile d'obtonir lo prompt intornomont dans lo lazaratdos personnes affect^es ; mais une fois entries la separation est comDldto et pormanente. ^ om th. hyglonio, tho rtlotetlc, or 'h» "•dlclnjl «J^to."J '»• ""• V. .fVhn HU.UB? Doc» IfDroirevor undergo « iponlnneouj cure? »nd If lo, at wD»i suiKr :; o Z dl..." T A?e Vo" »wiA what rr/oortlo'; of the l.pron. poor, tre.led at the pubfl. " expense, In New Brnniwlck, recorer wliolly or partially? A 15— Ai the retmlt of long observation, I am convinced tnat good hygienio ^' "' moulnroH. ndndingaV'«^«y'''«™ of heaUhy lie', ^aa great power m chocking rapid progre»«Tn the diseaao-life i« thereby prolonged. I have never observed more than n temporary amelioration from any medicinal trealment, and only Buch «, might be attributed tx, the influence Tf the mind over the body. My predeceesor used coloured water aooom- paiicd by strong assurances of binefit therolrom, and in every in«Unce Found a temporary improvement, equal in degree to any apparent benefit ho ?ouud f " m the use of medicinal agenU. I Snow of no "Pontaneous o^e Sf the disease, although I know inBtancoB o temporary abeyance of the diHoaso, lasting, in some cases, during a considerable period. ■' and the population in each of luch townihipi or diitricU I A«.16imdl7.-An8wer9 t« these questions being a ^^f.^^ 7"«' «^XS?1 staliHtical facts, my reply to each would be a repetition of Dr. Taoh6 s reply. I therefore beg to refer to his statements. Q. U.— JR. 14.— La malodie out on d^croiHHanco 3uarante maliules du lazarot. « -..vnuuu uono uimmui 08 conditions du poupio et d la iiquettralim dea maladu Q. is, A ano lortaino ^pxiuo, 11 y avuit vtrtm de J'attribuo cotto diminution A TamiSliortttion l2S^^iH.?."n '.%?.* '^^ 7 ConD.I„.|,.ToM U proportion del l*r^ui mi^ltl'n" pir "eui qu '\gn4rlnentenil6r«mentou p«rU«llemont, d«ni le Nourenu-Bfuniwlek!" ai«i qui B. 16.-Comme rtsnltat d'uno ionguo oxp6rionco, jo suIh convaincu quo do bonno* moeuree hygidniquoH, compronant un rigirr.o alimontairo sain et r^Kuiior ont pour offot do rotardor les prcgrds du mal, ot do prolongor la vio. Jo n ai jamam obsorvi qu'uno amelioration tomporairo rdinltant d'un trtitomont mWical, ot tollo Moulomont qu'on mai attribuor A I'influonco do I esprit 8ur le corps. Mon prW^coBHour a fait usage d'oau colorio, acoom- pagnio d assurances de bons r^sultats, ot chaque fois il a pu constator uno amelioration paesagdro 6jja e, en apparanco, A oolle qu'il avait vu so pro- dniro k la suite do Pomploi do medicaments. Je no connais poH do cal^do gndrison spontonde; maisjo connais des caa do eusponaion do la maladie. quolqnes-uns d'uno dur6o considdrablo. Q. 16 etlTjp-^' Quelle M^^^^ NouTcau-BruD.wick et qnand . .u lieu le dernier « «n,..^ ;?' JA A*'*"''" "" •y,"*'"8 g6n6r«l et unlforme d'enregUtrement ded inU- '< dSnn.ru Lmh,. ^o A °'" "on""" 1m cantcn. ou distrlcU oil la 16rre .« rencontre et donner le nombre dea lipreui et le chiffre do la population d» chacune de ces locallt6« I'- ll. 16 at 17.— Los reponsoB A ces questions 6tant siinplo matidre de fails statistiquos, je no pourrais que r6p«ter oo que le Dr Tach6 a consignd dans I'dtat qu'll loornit, je domando done pernisBlon de renvoyor A sea riponsos.