j^oi^fni^^jf^rt^^rikH^U. j (^ J? Q 
 
 DUPLICATE 
 
 HXOOO 12882 
 
 IS LEPRUSY INCREASING? 
 
 By 
 
 FREDERICK L. HOFFMAN, LL. D., F. S. S., F. A. S. A. 
 
 Third Vice President and Statistician, The Prudential Insurance Company 
 
 of America, Associate Fellow American Medical Association, 
 
 Member Royal Sanitary Institute, Member American 
 
 Public Health Association, etc., etc. 
 
 AN ADDRESS 
 
 Delivered at a meeting of the American Medical Association 
 New Orleans, La., April 26, 1920 
 
 
SCIENTIFIC PUBLICATIONS 
 
 STATISTICIAN'S DEPARTMENT 
 
 THE PRUDENTIAL INSURANCE COMPANY OF AMERICA 
 
 HOME OFFICE, NEWARK, NEW JERSEY 
 
 (AVAILABLE ON REQUEST) 
 
 INDUSTRIAL HYGIENE 
 Industrial Accidents and Their Relative Frequency in Different Occupations (1914). 
 The Mortality from Diseases of the Lungs in American Industry (1916). 
 Some Theoretical and Practical Aspects of Industrial Medicine (1917). 
 Mortality from Respiratory Diseases in Dusty Trades — Inorganic Dusts (1918). 
 Menace of Dust, Gases and Fumes in Modern Industry (1918). 
 
 HEALTH INSURANCE 
 Facts and Fallacies of Comptdsory Health Insurance (1917). 
 Public Health Progress Under Social Insurance (1917). 
 Autocracy and PaternaUsm versus Democracy and Liberty (1918). 
 Failure of German Compulsory Health Insurance: A War Revelation (1918). 
 Health Insurance and the Public (1919). 
 
 More Facts and Fallacies of Compulsory Health Insurance (1919). 
 National Health Insiurance in Great Britain (1920). * 
 
 CANCER 
 
 Educational Value of Cancer Statistics (1914). 
 Accuracy of American Cancer Mortality Statistics (1914). 
 The Mortality from Cancer Throughout the World (1915). 
 Cancer from the Statistical Standpoint (1916). 
 
 MALARIA 
 A Plea and a Plan for the Eradication of Malaria in the Western Hemisphere (1916). 
 The Malaria Problem in Peace and War (1918). 
 
 MISCELLANEOUS 
 
 Rural Health and Welfare (1912). 
 
 Uniformity of Annual Reports of Local Boards of Health (1913). 
 
 The Chances of Death and The Ministry of Health (1913). 
 
 The Economic Progress of the United States During the Last Seventy-five Years( 1914) 
 
 American Public Health Problems (1915). 
 
 Leprosy as a National and International Problem (1916). 
 
 The Sanitary Progress and Vital Statistics of Hawaii (1916). 
 
 On the Physical Care of Children (1916). 
 
 The Tuberculosis Death Rate in 1916 (1917). 
 
 Army Anthropometry and Medical Rejection Statistics (1917). 
 
 The Mortahty from Degenerative Diseases (1918). 
 
 A Plan for a More Effective Federal and State Health Administration (1919). 
 
 Pauper Burials and the Interment of the Dead in Large Cities (1919). 
 
 Some Statistics of Influenza (1919). 
 
 Is Leprosy Increasing (1920)? 
 
 CHARTS 
 
 Typical Causes of Death Infant Mortality Typhoid Fever 
 
 Cancer Infantile Paralysis Accidents 
 
 Influenza Diphtheria Mortality of the United States 
 
 Leprosy Measles and Germany 
 
 Malaria Scarlet Fever Pauper Burials 
 
 Tuberculosis Whooping Cough Army Anthropometry 
 

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IS LEPROSY INCREASING? 
 
 FREDERICK L. HOFFMAN, LL. D., F. S. S., F. A. S. A. 
 
 Third Vice President and Statistician, The Prudential Insurance Company 
 
 of America, Associate Fellow American Medical Association, 
 
 Member Royal Sanitary Institute, Member American 
 
 Public Health Association, etc., etc. 
 
 AN ADDRESS 
 
 Delivered at a meeting of the American Medical Association 
 New Orleans, La., April 26, 1920 
 
1920 
 
 PHUDENTIAL PRESS 
 
 NEWARK, N. J. 
 
 U. S. A. 
 
 Foreign Agents 
 
 Messhs. p. S. king & SON, LTD. 
 
 2 AND 4 GREAT SMITH ST. 
 
 LONDON, ENG. 
 
CONTENTS 
 
 Page 
 
 The Extent of Leprosy in the United States 5 
 
 Estimate by Dr. Isadore Dyer 5 
 
 Estimate by Dr. Howard Fox 5 
 
 Estimate by Dr. Martin F. Engman 6 
 
 The United States Senate Committee Inquiry 6 
 
 The Literature of Leprosy 6 
 
 Modern Views on Segregation 7 
 
 Leprosy in Louisiana 8 
 
 Leprosy Admissions, by Race, Sex, and Average Age 10 
 
 Varieties of Leprosy in Louisiana 10 
 
 The Fatality Rate in Leprosy 11 
 
 Discharges and Cures 12 
 
 Absconding Cases 12 
 
 Deportations 13 
 
 Leprosy in the Young 13 
 
 Treatment and Cure 14 
 
 Leprosy in California 14 
 
 Leprosy in Massachusetts 14 
 
 Leprosy in the United States Registration Area 14 
 
 Revised Estimate of Leprosy Cases in the United States 15 
 
 Urgent Need for a Federal Leprosarimn 16 
 
 Leprosy in Canada _. 16 
 
 Leprosy in Cuba 16 
 
 Leprosy in Porto Rico 17 
 
 Leprosy in Panama Canal Zone 17 
 
 Leprosy in Rio de Janeiro 18 
 
 Leprosy in Sao Paulo 18 
 
 Leprosy in Brazil 18 
 
 Leprosy in Argentine Republic 19 
 
 Leprosy in Venezuela 19 
 
 Leprosy in Barbados 19 
 
 National Conference on Leprosy in Argentina 20 
 
 Geographical Distribution in Brazil 20 
 
 Urgency of a Broader National Interest 20 
 
 Recent Cases of Leprosy Throughout the United States, 1916-1920 21 
 
 Urgency of a More Qualified Professional Interest 21 
 
 Cases of Leprosy in the United States Reported Since 1916 22-27 
 
 Need and Value of a National Leprosy Conference 27 
 
 Medical and Dermatological Aspects of Leprosy 28 
 
 Present Status of the Federal Leprosarium 30 
 
 Importance of Accurate and Complete Leprosy Statistics 31 
 
 Summary of Conclusions 32-34 
 
CONTENTS (Continued) 
 
 Page 
 
 Appendix A — Leprosy in India 35-40 
 
 Appendix B — Leprosy Statistics : 
 
 Leprosy Admissions — Louisiana Leper Home 41 
 
 Leprosy Admissions by Age and Sex 41 
 
 Leprosy Admissions — San Francisco, Calif 42 
 
 Leprosy Admissions — Massachusetts 42 
 
 Leprosy Deaths — United States Registration Area 43 
 
 Leprosy Deaths by States 43 
 
 Leprosy Mortality in Cuba 44 
 
 LeprosyCases in Cuba 44 
 
 Leprosy in Porto Rico 44 
 
 Leprosy in Panama Canal Zone 45 
 
 Leprosy in City of Rio de Janeiro 46 
 
 Leprosy in Sao Paulo 46 
 
 Leprosy in Federal District of Rio de Janeiro 47 
 
 Leprosy in Pernambuco 47 
 
 Leprosy in Venezuela 48 
 
 Leprosy in Barbados 48 
 
 Leprosy in India 49 
 
 Leprosy Statistics — Hawaii 49-51 
 
 Leprosy in Union of South Africa 51 
 
 Leprosy in United States, 1920 — by States 52-53 
 
 CHARTS 
 
 Leprosy in the United States , Frontispiece 
 
 Leprosy in Louisiana 9 
 
 Leprosy in Hawaii 29 
 
IS LEPROSY INCREASING! 
 
 The Extent of Leprosy in the United States 
 The question as to whether leprosy is on the increase in this country 
 is one of considerable medical, general scientific, and humanitarian inter- 
 est. The question, unfortunately, can not be answered in a satisfactory 
 manner by an appeal to thoroughly trustworthy statistics, for neither the 
 Federal Government nor any one of the several States has undertaken an 
 investigation commensurate with all that is involved in whatever answer 
 may be forthcoming. At best only an approximate guess can be advanced 
 as to the probable number of lepers in the United States at the present 
 time, but it is safe to assume that the actual number is less than the earlier 
 estimates would seem to justify. An attempt to answer the question by 
 an appeal to statistical evidence was made at the time when the Senate 
 Committee on Public Health and National Quarantine considered the 
 establishment of a national leprosarium for the care of leprosy cases, 
 chiefly of an international or interstate character. The results of several 
 inquiries made of State and local boards of health throughout the country 
 seem to indicate that there are probably not far from two hundred and 
 fifty officially known cases of leprosy in the United States, and possibly 
 as many as five hundred cases known and suspected. The United States 
 Public Health Service has given publicity to similar inquiries but they 
 have never been inclusive of all the States and the localities not required 
 to report to some central authority.* 
 
 Estimate by Dr. Isadore Dyer 
 Dr. Isadore Dyer, of New Orleans, probably the foremost leprologist 
 in the United States, in his evidence before the Senate Committee on Pub- 
 lic Health and National Quarantine, on March 26, 1916, referred to an 
 estimate, according to which the number of cases of leprosy in the United 
 States was four hundred, of which probably three hundred and fifteen were 
 cases in the State of Louisiana. This, however, was a statement based 
 upon inquiries made some years earlier, and Dr. Dyer in his evidence 
 presented a revised estimate, according to which he placed the number 
 of lepers throughout the United States in 1916 at from 800 to 1,200, 
 basing his conclusions upon the observed experience and apparent rate of 
 increase in the State of Louisiana. 
 
 Estimate by Dr. Howard Fox 
 Dr. Howard Fox, of New York, Clinical Professor of Dermatology, 
 also a recognized authority on leprosy, placed a statement before the 
 same committee, according to which the number of leprosy cases in the 
 
 ♦In 1907 the United States Public Health Service traced 139 cases of leprosy in the continental 
 United States. In 1912 the nnmber so ascertained was 146. In 1920, according to my own inquiry, there 
 are 242 cases. (See table XXIV, Appendix B.) 
 
United States was estimated at from 500 to 1,000. Dr. Fox, however, 
 apparently had based his estimates largely upon his experience in the 
 city of New York, where some thirty cases had come mider his personal 
 observation. According to his estimate the nmnber of cases of leprosy in 
 the city of New York at that time was fifty. 
 
 Estimate by Dr. Martin F. Engman 
 Dr. Martin F. Engman, Professor of Skin Diseases, Washington Uni- 
 versity, St. Louis, testified that, in his judgment, an estimate of 800 
 leprosy cases in the United States was entirely too low, and he went so 
 far as to intimate that the probable number was three times as large. In 
 support ofi his statement he directed attention to a return of the United 
 States Public Health Service for the year 1911, according to which there 
 was only one case of leprosy m Missouri, when, to his personal knowl- 
 edge, there were certainly at the time three cases in St. Louis alone. He, 
 however, was frank to say that it was impossible "to estimate the nmnber 
 of cases of leprosy in this coimtry with any accuracy at all." 
 
 The United States Senate Committee Inquiry 
 It would serve no practical purpose to enlarge upon the various esti- 
 mates presented, since in not a single case has the evidence been forth- 
 coming that a really thoroughgoing effort had been made to ascertain the 
 facts. It was my privilege at about that time to present to the Senate Com- 
 mittee a first effort to assemble the leprosy statistics of foreign countries 
 making at least fairly trustworthy returns, and a mass of material was 
 printed in the report of the committee, which is still available to those 
 who may wish to pursue the subject further. (Senate Report 306, 64th 
 Congress, 1st session, Washington, 1916.) 
 
 The Literature of Leprosy 
 
 In continuation of the earlier investigation (Senate Report of 1916), 
 I am now able to present some additional and more recent statistics, 
 which, though largely for other countries than the United States, certainly 
 emphasize the sinister aspects of leprosy occurrence in isolated cases 
 as they are met with from time to time in this coimtry. For, whatever 
 views may be held regarding the spread of the disease, no one can question 
 that leprosy foci, once thoroughly established, are extremely difficult, if not 
 impossible, to eradicate. The literature of leprosy is widely scattered and 
 difficult of access to those who suddenly find themselves confronted by the 
 necessity of the highly specialized care of some isolated case of leprosy, 
 usually, in this country, outside of Louisiana, contracted in the Philip- 
 pines, Hawaii, or the West Indies. 
 
 Among the more important works which throw light and a wealth of 
 useful information upon the etiology of this obscure disease, mention 
 requires to be made of "A Handbook on Leprosy," by S. P. Impey, M.D., 
 late chief and medical superintendent of the Robben Island Leper Asylum, 
 
Cape Colony, South Africa. Another very useful dissertation is a report 
 on leprosy in Hongkong, by James Cantlie, M.A., F.R.C.S., Hongkong, 
 1890. Of special value are the "Prize Essays on Leprosy," issued by the 
 New Sydenham Society in 1897, including, first, a contribution to the 
 history of leprosy in Australia, by J. Ashburton Thompson, M.D. ; and, 
 second, a report on the conditions under which leprosy occurs in China, 
 etc., compiled chiefly during 1894, by James Cantlie, One of the most 
 thorough investigations ever made into the subject is a report of the 
 Leprosy Commission of India (Calcutta, 1893), which may well be con- 
 sidered a model for a similar inquiry in this country. This investigation 
 includes the results of personal examinations and observations on the 
 geographical distribution of leprosy in its relation to climate, soil and 
 race, illustrated by properly drawn maps visualizing the local degree of 
 frequency of the disease throughout India. The observations on the local 
 incidence of leprosy are amplified by an extended consideration of such 
 involved questions as hereditary transmission and predisposition, con- 
 tagiousness, sanitation, diet, other diseases, and, finally, the important 
 question of proper treatment. Through the courtesy of G. M. Young, Esq., 
 Under-Secretary to the Governor of India, I have been favored with a 
 copy of this valuable report, and of a supplementary memorandum pre- 
 pared by a special committee in behalf of the National Leprosy Fund. 
 
 It is difficult to clearly grasp the significance of much of the general 
 discussion relating to leprosy at a time when the views of highly respected 
 authorities were widely at variance both as to the cause of the disease 
 and the methods of its transmission. I need only refer to the treatise on 
 "Leprosy and Fish Eating," by Sir Jonathan Hutchinson, and to even 
 better purpose to the report on "Leprosy and Yaws in the West Indies," 
 by Gavin Milroy, a fellow of the Royal College of Physicians, London, 
 1873; or, of more recent date, to the reports on "Nastin and Benzoyl- 
 chloride Treatment for Leprosy," by Dr. E. P. Minett, Assistant Govern- 
 ment Bacteriologist of British Guiana, London, 1912.* 
 
 Modern Views on Segregation 
 A review of the literature clearly emphasizes the inadequacy of the 
 medical and general scientific considerations of a disease which, partly 
 because of its obscurity and largely because of its more intensive limita- 
 tion to primitive races, has not attracted the attention to which it is cer- 
 tainly, by every himiane consideration, entitled at the present time. Even 
 
 ♦The modem literature of leprosy is so extensive as to preclude even a mere mention by title of the 
 most important contributions, but a reference requires to be made to one of the Prize Essays on leprosy 
 published by the New Sydenham Society, 1895, containing also an important paper by Doctor (now Sir) 
 George Newman, on "The History of the Decline and Final Extinction of Leprosy as an Endemic Dis- 
 ease in the British Islands." The same volume includes a most interesting essay on "Conditions Under 
 Which Leprosy has Declined in Iceland," by Edward Ehlers, M.D., and a paper on "Leprosy in South 
 Africa," by S. P. Impey, M.D., with some supplementary observations on "Spontaneous Recovery from 
 Leprosy," based upon self-cured cases, presented to the medical congress held in Cape Toivn. Of im- 
 portance also is a contribution to the New Orleans Medical and Surgical Journal of July, 1917, on "Early 
 Manifestations of Leprosy," by Doctor Ralph Hopkins, in medical charge of the Louisiana Leper Home. 
 Invaluable in this connection are the special reports upon leprosy prepared by the United States Public 
 Health Service, being the contributions made by the surgeons in charge of the United States Leprosy 
 Investigation Station in Hawaii. 
 
so useful and otherwise comprehensive a work as the new "Reference 
 Handbook of the Medical Sciences" limits the discussion of leprosy by 
 Dr. Dyer to less than six pages; but I may appropriately quote here Dr. 
 Dyer's conclusion that, "The sanitary control of leprosy should be prac- 
 ticed by every government for the protection of the public and for the 
 care of the leper. Segregation has proved the best method of checking the 
 spread of the disease and this is the basis of the practice in most coun- 
 tries." He therefore remarks, "National leprosaria will solve the question 
 of leprosy incidence, and the laboratory gives promise of finding some 
 specific." 
 
 It was largely upon this principle of precedure that the small group 
 of men who appeared before the Senate Committee in 1916 presented 
 their case and carried their point, for be it said to the honor of the United 
 States Cozigress that an appropriation was promptly made of $250,000, an 
 amoimt fully sufficient for the purpose. The bill was signed by the Presi- 
 dent on February 3, 1917. 
 
 In the argvmients presented to the committee emphasis Avas placed upon 
 the international aspects of the disease and the fact that, outside of the 
 State of Louisiana, most, if not nearly all, of the sporadic cases of 
 leprosy in the United States had been contracted in foreign countries or in 
 our non-contiguous territories. It was chiefly on this grovmd that the 
 Senate Committee made a favorable recommendation, it being clearly 
 understood that it was not the intention of the States represented to place 
 upon the Federal Government the burden of care in the case of leprosy 
 clearly or unmistakably of native origin. This conclusion applies par- 
 ticularly to the State of Louisiana, where leprosy has been met with for 
 more than a hundred years and where the disease has its largest endemic 
 center in the United States.* 
 
 Leprosy in Louisiana 
 
 The Louisiana Leper Home was established by an act of the General 
 Assembly of Louisiana, passed in the year 1894, the location of the home 
 being near Carville, in Iberville Parish, about sixty miles from New 
 Orleans, on the banks of the Mississippi River. 
 
 The nimiber of new cases admitted to the Louisiana Leper Home in 
 1894 (being opened on December 1st) was only eight, but during the fol- 
 lowing year eighteen cases were admitted, and since that time the number 
 has varied, reaching a maximum of twenty-seven new cases during the 
 year 1913. The average number of cases admitted during the period 1895- 
 1899 was seven, or 5.2 admissions per million of population per annum, 
 which compares or contrasts with an average of twenty-one cases annually 
 or llA admissions per million during the five years ending with 1917. 
 The number remaining in the institution at the time the report was made 
 in April, 1916, was 103, or the largest nimiber on record. The returns for 
 
 ♦There is record of a leper hospital at New Orleans as early as 1785. It has been claimed that the 
 disease was introduced by the Acadian refugees from Nova Scotia after their expulsion by the English. 
 
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the year 1919 are not available at this writing, but they will subsequently 
 be inserted as a matter of convenient record.* 
 
 The Louisiana data, which are given in full in table I of Appendix B, 
 seem to justify the conclusion that leprosy is increasing in Louisiana; or, 
 if not, that the niunber of ru)n-segregated patients is larger than is gener- 
 ally assumed to be the case. This, as I understand it, is the view held by 
 Dr. Dyer, whose judgment is entitled to the utmost consideration. It may 
 be said in this connection that leprosarium admissions depend largely 
 upon the reputation of the institution for the care and medical treatment 
 of the patients as well as for the beneficial results secured in particular 
 cases. 
 
 I^EPROSY Admissions by Race, Sex and Average Age 
 
 The Louisiana Leper Home is in many respects an admirable institu- 
 tion, which has been fortunate enough to be under the supervision of a 
 hmnane board conscious of its profoimd obligations towards the most 
 afflicted members of the community. It has, furthermore, the great advan- 
 tage of constant medical supervision on the part of Dr. Ralph Hopkins, 
 who makes a weekly visit to the institution, and more often if urgently 
 required. The table following presents an analysis of 257 cases admitted 
 to the institution during the period 1894-1915, differentiating the type of 
 the disease, the race and sex of the patient, and the average age on admis- 
 sion according to the diagnosed variety of leprosy : 
 
 analysis of admissions to leper home, la. 
 
 For the Period, December 1, 1894, to December 31, 1915 
 
 Average Age on Admission by Type of Disease 
 
 
 
 
 
 MALES 
 
 
 
 FEMALES 
 
 
 Type of 
 
 
 White 
 
 Colored 
 
 White 
 
 Colored 
 
 Disease 
 
 
 No. 
 
 Av 
 
 . Age Yrs. 
 
 No. 
 
 Av. Age Yrs. 
 
 No. 
 
 Av. Age Yrs 
 
 :. No. Av 
 
 .Age Yrs. 
 
 Tubercular 
 
 
 38 
 
 
 32 
 
 14 
 
 39 
 
 18 
 
 42 
 
 6 
 
 41 
 
 Anesthetic 
 
 
 32 
 
 
 28 
 
 6 
 
 34 
 
 19 
 
 35 
 
 3 
 
 27 
 
 Mixed 
 
 
 46 
 
 
 33 
 
 10 
 
 41 
 
 30 
 
 36 
 
 6 
 
 31 
 
 Trophic 
 
 
 10 
 
 
 36 
 
 2 
 
 53 
 
 4 
 
 31 
 
 3 
 
 58 
 
 Unknown 
 
 
 2 
 
 
 40 
 
 — 
 
 ■ — 
 
 — 
 
 — 
 
 — 
 
 — 
 
 Total 
 
 
 128 
 
 
 32.0 
 
 32 
 
 39.5 
 
 71 
 
 37.1 
 
 18 
 
 38.1 
 
 Ages Unknown 
 
 4 
 
 
 — 
 
 1 
 
 — 
 
 2 
 
 — 
 
 — 
 
 — 
 
 
 
 
 
 Males and Females 
 
 
 
 
 
 
 
 
 
 
 
 No. 
 
 
 Av. Age Yrs. 
 
 
 
 Tubercular 
 
 
 
 
 76 
 
 
 
 36.4 
 
 
 
 Anesthetic 
 
 
 
 
 60 
 
 
 
 31.0 
 
 
 
 Mixed 
 
 
 
 
 
 92 
 
 
 
 35.0 
 
 
 
 Trophic 
 
 
 
 
 
 20 (x) 
 
 
 
 41.7 
 
 
 
 Unknown 
 
 
 
 
 2 
 
 
 
 40.0 
 
 
 
 Total 
 
 
 
 
 
 250 
 
 
 
 35.0 
 
 
 
 Age Unknown 
 
 
 
 7 
 
 
 
 
 
 (x) Includes one Chinese, age 75. (Male.) 
 
 Data from Biennial Reports of the Board of Control. 
 
 Varieties of Leprosy in Louisl\.na 
 Of the 257 admissions, 205, or 79.8 per cent., were white persons. 
 The corresponding proportion of whites in the total population of Louisi- 
 
 *The number remaining in 1920 is 87. 
 
 10 
 
ana was 56.9 per cent, at the time of the 1910 census. The average age 
 on admission, disregarding the type of the disease, was 32 years for white 
 males and 39.5 years for colored males. For white females the average 
 age on admission was 37.1 years, and for colored females, 38.1 years. 
 There would, therefore, appear to be a tendency towards a somewhat 
 higher age on admission in the case of the colored patients. 
 
 Combining both races and sexes, of the 257 admissions, 77, or 30.0 
 per cent., were of the clearly differentiated tubercular variety, 62, or 24,1 
 per cent., were of the anesthetic variety, and 95, or 37.0 per cent., were of 
 the mixed variety, the proportions varying according to race and sex, but 
 it is safe to say that the mixed variety is the predominant type. The fact 
 that the mixed variety predominates complicates the question of treatment 
 and makes segregation even more important than would ordinarily be the 
 case. The mixed variety apparently has a slightly higher average age on 
 admission, while the anestlietic variety has a lower age than the tubercular 
 for both sexes and both races separately considered. 
 
 The Fatality Rate in Leprosy 
 The next table shows an analysis of the experience during the period 
 1894-1915, indicating the fatality ratios and the cures, with a due regard 
 to sex and type of disease: 
 
 ADMISSIONS TO THE LOUISIANA LEPER HOME 
 
 According to Type of Disease, Mortality, and Cures 
 December 1, 1894, to December 31, 1915 
 
 Males 
 
 Type of 
 
 Admissions 
 
 I 
 
 )ied 
 
 Disease 
 
 No. 
 
 No. 
 
 % 
 
 Tubercular 
 
 52 
 
 18 
 
 34.6 
 
 Anesthetic 
 
 40 
 
 9 
 
 22.5 
 
 Mixed 
 
 58 
 
 38 
 
 65.5 
 
 Trophic 
 
 13 
 
 7 
 
 53.8 
 
 Unknown 
 
 3 
 
 — 
 
 - — 
 
 Total 
 
 166 
 
 72 
 Females 
 
 43.4 
 
 Tubercular 
 
 25 
 
 6 
 
 24.0 
 
 Anesthetic 
 
 22 
 
 9 
 
 40.9 
 
 Mixed 
 
 37 
 
 20 
 
 54.1 
 
 Trophic 
 
 7 
 
 4 
 
 57.1 
 
 Unknown 
 
 
 — 
 
 
 Total 
 
 91 
 
 39 
 
 42.9 
 
 
 
 Males and Females 
 
 Tubercular 
 
 77 
 
 24 
 
 31.2 
 
 Anesthetic 
 
 62 
 
 18 
 
 29.0 
 
 Mixed 
 
 95 
 
 58 
 
 61.1 
 
 Trophic 
 
 20 
 
 11 
 
 55.0 
 
 Unknown 
 
 3 
 
 — 
 
 
 Ci 
 
 jred 
 
 No. 
 
 % 
 
 2 
 
 3.8 
 
 4 
 
 10.0 
 
 1 
 
 1.7 
 
 4.2 
 
 6 24.0 
 4 18.2 
 2 5.4 
 
 12 13.2 
 
 8 10.4 
 8 12.9 
 3 3.2 
 
 Total 
 
 257 
 
 111 43.2 
 
 11 
 
 19 7.4 
 
Discharges and Cures 
 
 The interesting fact is brought out by this table that of the total male 
 admissions, numbering 166, seven cases, or 4.2 per cent., were discharged 
 as cured. Of 91 females, twelve cases, or 13.2 per cent., were discharged 
 as cured, but it is hardly safe to draw far-reaching conclusions according 
 to the type of the disease and the apparent degree of curability, with refer- 
 ence to sex, on account of the smaller number of women patients under 
 observation. In the case of male patients, however, it is significant that the 
 proportion of deaths should have been highest for the mixed type of the 
 disease, or 65.5 per cent, of the admissions, the corresponding percentage 
 for females having been 54.1. For the tubercular type of the disease, the 
 mortality rate was 34.6 per cent, for males and 24.0 per cent, for females. 
 The fatality rate, of course, is largely influenced by the duration of treat- 
 ment and the attained age of the lepers under segregation, as well as by 
 the rate of admission of new cases. No definite conclusions can be drawn 
 from this experience as to the greater or lesser degree of curability of 
 specified types of leprosy, but the method used emphasizes the value of 
 an extended statistical analysis of the facts derived from a larger area of 
 observation. For all types combined the mortality rate was 43.4 per cent, 
 for male patients and 42.9 per cent, for female patients, or almost the same. 
 
 Many other interesting facts are brought out by the statistical tables 
 appended to this discussion, which are practically self-explanatory. With- 
 out unduly enlarging upon the facts as disclosed by table II, Appendix B, 
 it may be said in this connection that the age period at which the larger 
 proportion of leprosy admissions occurred in Louisiana was 20-29. At this 
 period of life there were 34 admissions, or 20.5 per cent, of the total of 166 
 male admissions, while of 91 females the greatest number was admitted at 
 ages 40-49, but almost the same niunber was admitted at ages 20-29. A 
 discussion of the statistical results of this investigation is naturally difficult 
 on account of the race factor, which can not be safely ignored, but an 
 extended consideration of which would unduly trespass upon the time 
 available, and more so in view of the fact that the details are given in the 
 tables in the appended tabular analysis. 
 
 Absconding Cases 
 It has not been possible for me to deal with the question of escapes, 
 but from every center of leprosy the information is clearly to the effect 
 that escapes are not only inadequately safeguarded against but in some 
 cases encouraged. The Early case of the District of Columbia is a con- 
 spicuous illustration of our failure to recognize the menace of leprosy 
 to the community at large. Most of the cases apprehended have previously 
 been unrecognized leper residents of other communities. In Louisiana last 
 year fifteen cases absconded, but what became of these cases is not known. 
 In California last year at least three cases, and probably more, escaped 
 from detention hospitals. It is always a foregone conclusion that an 
 
 12 
 
escaped leper will be apprehended within a comparatively short period 
 of time on account of the urgency of the special treatment required to 
 bring relief. In view, however, of the recognized infectious character of 
 the disease, or its transmission from person to person by actual contact, 
 the danger to the community on account of such cases is real and not 
 imaginary.* 
 
 Deportations 
 
 I am not able to discuss in full detail the question of deportations. The 
 reports of the Surgeon General do not indicate how many lepers are annu- 
 ally deported. Under the law a foreign-born leper must be a resident 
 of this country five years before he acquires a settlement. Most of the 
 cases of foreign-born lepers have been residents of this country for 
 many years, although the disease was unquestionably contracted abroad. 
 Accurate information would be of value, for unquestionably leprosy im- 
 portations would be discouraged if the facts of deportation were better 
 understood. It would also be of value to have the duration of previous 
 residence in this country accurately ascertained to determine whether cases 
 should be deported that now are a burden and expense to communities ill- 
 provided with proper facilities for leprosy care. The question may be 
 raised in this connection whether our methods of examination for leprosy 
 at quarantine are really adequate to the purpose. It does not appear that 
 special emphasis is placed upon the urgency of ascertaining cases of 
 leprosy in the incipient stage of the disease. It is possible that the Bureau 
 of Immigration has information on the subject, for the records should 
 show the number of cases refused admission to this country on account of 
 leprosy, as well as the number deported. 
 
 Leprosy in the Young 
 
 One important phase of the subject is leprosy in the young. There are 
 in this country at the present time a number of very suggestive cases of 
 children suffering from leprosy evidently contracted from leprous parents. 
 There are or were two or three such children at the Alameda County 
 Hospital, Oakland, Cal., and there are at present two such children at 
 Phillipsburg, N. J., ill-provided with the required special institutional 
 care. Since a leper under certain conditions may live for many years with 
 the disease in a quiescent or arrested stage the pecuniary aspects of this 
 question are a matter of serious importance to the localities concerned. 
 
 *The importance of this observation is illustrated by the very recent case of Willard Centliver, a leper, 
 who surrendered to the authorities of the City of Washington, as reported in the Washington Post of 
 March 28, 1920. He had arrived in Washington a few days before from Birmingham, Alabama, having 
 made the trip in a Pullman car, but he had destroyed the car check so as to preclude the identification 
 of the method by which he had evaded detection. This man was accepted for army service in New 
 Orleans in 1917, having subsequently been transferred to Camp Beauregard, Louisiana. His condition being 
 ascertained, he was sent to the Louisiana Leper Home from which he escaped and went to Houston, Texas. 
 From there he returned to New Orleans and subsequently by way of Birmingham reached Washington, where 
 he entered a clinic and reported his condition. He could give no explanation as to how or where he had 
 contracted the disease. 
 
 13 
 
Treatment and Cure 
 The question of treatment and cure does not fall within the present 
 discussion but it has an important bearing upon the problem of leprosy 
 increase in that the numbers remaining are naturally determined in part 
 by the results of institutional care. There is apparently a distinct tendency 
 towards a larger proportion of cases discharged as cured, or certainly in 
 an arrested condition of the disease, justifying a diagnosis of at least 
 relative harmlessness to the community at large. In proportion, however, 
 as cases to an increasing extent are discharged as cured the number remain- 
 ing would indicate a diminished frequency of leprosy in the community, 
 although the contrary might be the case. This fact is frequently overlooked 
 in discussions of leprosy increase, and care is therefore necessary in con- 
 sidering the statistical results. 
 
 Leprosy in California 
 One of the most important centers of leprosy in the United States is 
 the Isolation Hospital at San Francisco, where generally from fifteen to 
 twenty lepers are segregated by the County of San Francisco, there being 
 in addition some nine lepers at the County Hospital of Alameda County, 
 near Oakland. The leprosy cases in San Francisco show no material in- 
 crease during recent years, bift there are reasons for believing that cases 
 are not effectively segregated, but apprehended in other counties, as best 
 illustrated by some very interesting apprehensions in Fresno, in the heart 
 of the San Joaquin Valley; and even more so by the Los Angeles County 
 Hospital, where at the present time five lepers are under control. Details 
 regarding the San Francisco cases are appended hereto (table HI, Ap- 
 pendix B), but it must be kept in mind that it is always more difiGcult to 
 secure trustworthy data for institutions which care for only a small number 
 of cases, not on the basis of adequate leprosy segregation but rather on the 
 principle of isolation and quarantine control. 
 
 Leprosy in Massachusetts 
 Some exceptionally interesting data are available for the Massachu- 
 setts Leper Colony at Penikese Island, in Buzzard's Bay, where the num- 
 ber under segregation is generally about twelve, but probably some- 
 what higher at the present time, a maximum having been reached in 
 1913, when fifteen cases were under segregation.* Some interesting details 
 of racial origin, age, and type of disease, are also included in the appen- 
 dix (table IV, Appendix B.) 
 
 Leprosy in the United States Registration Area 
 The foregoing statistics indicate the best sources of leprosy informa- 
 tion for the United States, but there can be no question of doubt that the 
 disease is widely scattered and that obscure cases occur here and there, 
 though frequently erroneously diagnosed or not recognized at all except 
 
 ♦Number under segregation on January 1, 1920 was 13, with 2 more cases reported during the month. 
 
 14 
 
in the terminal stage of the disease. It may be pointed out in this connec- 
 tion that in the United States registration area, with a population of 
 about 82,000,000 in 1918, there occurred twenty-four deaths from leprosy, 
 equivalent to a rate of 0.29 per million of population. The rate in the 
 registration area has apparently increased gradually from 0.13 in 1900 
 to 0.19 in 1910, and, as stated, to a maximum figure of 0.29 in 1918. 
 (Table V, Appendix B.)* 
 
 Revised Estimate of Leprosy Cases in the United States 
 
 If the normal death rate of leper cases is placed at 80 per 1,000 tmder 
 segregation, then the twenty-four deaths from leprosy which occurred in 
 the United States in 1918 would be equivalent to 300 probable cases of 
 leprosy in the registration area, and if this figure is applied to the con- 
 tinental United States, the number of leper cases, on a very conservative 
 basis, is not less than 400. 
 
 The distribution of leprosy deaths in the registration States, by single 
 years, since 1900, is given in table VI of Appendix B, but the fact must not 
 be overlooked that some of the States have been included in the registration 
 area during recent years only. The inadequacy of this return is made 
 clear by the statistics for the State of New York, where unquestionably 
 a larger number of deaths from leprosy occur than the recorded two 
 deaths, for illustration, during 1918. There has been for many years 
 an attitude not far from indifference on the part of the New York authori- 
 ties towards the imperative medical and humane duty of segregation, 
 which is so much more lamentable since it is safe to assume that there are 
 certainly not less than thirty and possibly as many as fifty cases of leprosy 
 in the city of New York at any given time. That cases in the city of New 
 York are of national concern is shown by sporadic outbreaks. Cases in 
 New Jersey, for illustration, have been directly traceable to leprosy con- 
 tact on Blackwell's Island. There are at the present time two leper chil- 
 dren in Phillipsburg, N. J., whose mother died from the disease in the 
 city of New York.f 
 
 If, therefore, the available statistical evidence is not entirely conclusive 
 it is certainly extremely suggestive of a possible, though slowly increasing, 
 frequency of this most dreaded of all human afflictions. The experience 
 which has been had in other countries proves conclusively that leprosy 
 increases as long as segregation is neglected, but that the disease slowly 
 declines when the cases are brought under control in one or more care- 
 fully supervised institutions such as the act of February 3, 1917, provides 
 shall be established in the United States under the direction of the United 
 States Public Health Service. 
 
 *0f course, not all lepers die of leprosy, so that the reported figure is an understatement of the 
 whole truth of leprosy occurrence in the registration area. See table IX, Appendix B, for Barbados. 
 
 tFor the official viewpoint that leprosy is not contagious or infectious in this climate, see J. A. 
 M. A. of November 13, 1897, p. 1021. and November 27, 1897, p. 1126. 
 
 15 
 
Urgent Need for a Federal Leprosarium 
 The urgency of a federal leprosarium is not questioned by anyone 
 familiar with the facts. It requires only to be considered that during the 
 period 1907-18 there have been not less than 138 deaths from leprosy 
 in the United States registration area, which is exclusive of a considerable 
 rural and Southern section in which leprosy cases are likely to occur. 
 Delay in the establishment of a federal institution for the care of lepers 
 must therefore be considered, on humane as well as on medical grounds, 
 a wrongful indifference on the part of those who are responsible for 
 the execution of the law". The obstacles to the selection of a suitable 
 site can not be considered serious, and least so in the case of Ship Island, 
 Miss., where there are suitable buildings which could long since have been 
 converted into a most useful institution for the care and relief at least of 
 interstate and international leprosy cases throughout the South. Before 1 
 enlarge upon the practical aspects of the question of adequate care under 
 segregation it may not be out of place to direct attention to certain facts 
 of leprosy occurrence throughout the Western Hemisphere which bear 
 directly upon our own problems at home. 
 
 Leprosy in Canada 
 
 There has for many years been a very limited leprosy center in the 
 Province of New Brunswick, dating back certainly as far as 1815, and prob- 
 ably to a much earlier period. As many as thirty-two lepers were segre- 
 gated at Shell Island about 1844, and these were later transferred to the 
 present leprosarium at Tracadie, where twenty-one lepers were cared for 
 in 1863. As the result of segregation the number of patients has gradually 
 diminished to twenty-four in 1898 and fourteen in 1916 with no new admis- 
 sions for the two years preceding the date of the last return. In 1907 the 
 Canadian government assimied federal control over all leprosy cases, and 
 a lazaretto was established at Darcy Island, B. C, for the care of cases on 
 the Pacific coast. There have been sporadic cases of leprosy in Manitoba, 
 chiefly of Icelandic or Scandinavian origin. It may be questioned whether 
 there are more than twenty-five active cases of leprosy throughout Canada 
 at the present time. There were five cases at Darcy Island in 1919 and thir- 
 teen cases at Tracadie. 
 
 Leprosy in Cuba 
 
 In Cuba there occur probably fifty deaths from leprosy per annum, 
 equivalent to a rate of 20 per million of population. As far as it is pos- 
 sible to judge the disease is slightly on the increase, partly because of 
 the lack of adequate methods of segregation, although probably more is 
 done by the Republic of Cuba than in the United States. In Cuba leprosy 
 appears to affect chiefly the white population, for in 1914 there were 
 thirty-five deaths of white lepers to ten deaths from leprosy among the 
 negroes. (See tables VII and VIII, Appendix B.) * 
 
 ♦According to the Bulletin of the Pan-American Union for September, 1916 "The construction of a 
 new leper hospital building was provided for at an expense not exceeding three hundred thousand dol- 
 lars." In January, 1917, the lepers under segregation at the lazaretto in the city of Havana remon- 
 strated against their proposed removal to the new institution at Mareal. Out of one hundred and leventy- 
 four lepers, it is said twenty escaped. 
 
 16 
 
Leprosy in Porto Rico 
 
 In Porlo Rico leprosy is fairly common, the number of known cases 
 being thirty-nine in 1919, or 30.9 per million of population. This com- 
 pares with about 154 known leper cases per million population for 
 Cuba, but the evidence of an increase in the frequency of the disease is 
 much more pronounced for Porto Rico, or, for illustration, a rate of 17.3 
 for 1905 contrasts with 24.3 for 1912 and 30.9 for 1919. (See table IX, 
 Appendix B.) * 
 
 Leprosy in Panama Canal Zone 
 
 In the Panama Canal Zone leprosy is also of relatively common occur- 
 rence, the lepers being segregated in a settlement at Palo Seco, near the 
 canal entrance, including, however, admissions of Panamanians from the 
 republic at large. The number of cases remaining under observation in 
 1918 was seventy-six, or 693 per million of population, a very marked 
 excess over the known rates for Cuba and Porto Rico. There were eight 
 deaths from leprosy in 1918, equivalent to a rate of 72.9 per million of 
 population, which compares with the rate of 19.7 for Cuba for the year 
 1914. The returns for the Panama Canal Zone also indicate an increase, 
 at least in the recorded frequency of leprosy, the rate having been 137.1 
 for 1907, 348.6 for 1913, and 692.6 for 1918. The Palo Seco returns, 
 however, are not entirely complete in that sporadic cases of leprosy are 
 occasionally taken care of in the hospitals of the Panama Canal Zone. 
 It may be said in this connection that the prevailing variety of the disease 
 in Panama is tubercular, or twenty-four deaths out of thirty-three during 
 the period 1907-1915; while an overwhelming proportion of admissions 
 is represented by native Panamanians and negroes, there having been only 
 three deaths of white persons during the period under review out of a 
 total of thirty-three deaths of all races and nationalities. Two of the white 
 decedents were natives of the United States. 
 
 The Senate report on leprosy contains much information concerning 
 the frequency of the disease throughout the West Indies, which to enlarge 
 upon would unduly trespass upon the time available for the present dis- 
 cussion. It seems advisable, however, to briefly direct attention to the 
 leprosy returns for certain countries of South America, which are deserving 
 of more consideration than has heretofore been given to the relative fre- 
 quency of the disease in the Pan-American republics. (See tables X and 
 XI, Appendix B.) 
 
 *The lepers of Porto Rico are isolated on Cabras Island at the entrance of San Juan Bay. In 1917, 
 however, this institution had only thirty-four patients. The Journal of the Porto Rico Medical Association 
 quoted in the Journal of the American Medical Association of 1918 contains the report of a committee 
 appointed to investigate leprosy conditions in Porto Rico. This report brought to light decidedly unsatis- 
 factory conditions, particularly as to the water supply and acessibility. The committee recommended that 
 the present site be abandoned and that the lepers be removed "to a fertile portion of the mainland of 
 Porto Rico," and that "principles of modern sanitary management be applied to the care and treatment of 
 the disease in place of the present state of hopeless isolation." The New York Times of April 13, 1919, 
 contains an account of this colony reflecting seriously upon existing conditions, stating the sanitary con- 
 ditions to be deplorable and directing attention to the totally inadequate medical supervision. The article 
 concludes with the statement that "Common human kindness should prompt the authorities of Porto Rico 
 to have the unfortunates transferred to some other place, where at least they could keep dry in damp 
 weather." and, it is said, "Surely these poor outcasts need some one's help." 
 
 17 
 
Leprosy in Rio de Janeiro 
 For Rio de Janeiro the statistics indicate a relative mortality from 
 leprosy of about 30 per million of population, there having been twenty- 
 three deaths from this disease in 1918. The returns are available since 
 1890 and indicate neither a pronounced tendency towards an increase nor 
 a decided diminution. It may therefore be said that the disease has 
 apparently reached a stationary condition, in Rio de Janeiro at least, 
 while for Recife (Pernambuco), the available data indicate a decided 
 decrease since 1907, from a rate of 112.9 per million of population to 37.5 
 in 1917. (See table XII, Appendix B.) 
 
 , Leprosy in Sao Paulo 
 
 For the city of Sao Paulo, however, the returns are less reassuring, 
 for there the condition also appears to be apparently a stationary one. 
 In 1901 the nmnber of deaths from leprosy was equivalent to 17.5 per 
 million, but by ] 910 the rate had increased, probably due largely to more 
 accurate methods of reporting, to 65.6. In 1917 the rate was 57.5 per 
 million, but apparently the changes in the rates can not be relied upon as 
 a definite indication of an increase or decrease in the frequency of the 
 disease. (See table XIII, Appendix B.) 
 
 Leprosy in Brazil 
 
 Some interesting statistics are available for the Federal District of 
 Rio de Janeiro, for the period 1909-18, indicating a relative annual mor- 
 tality from leprosy of 27.9 per million of population for males and 
 18.8 for females. The rate increases with age, as shown by a table 
 hereto appended, from a minimum mortality in infancy to a maximmn 
 mortality in advanced adult life. (Table XIV, Appendix B.) 
 
 In addition, there is included a table of leprosy mortality in the 
 Federal District of Rio de Janeiro, by nativity, showing, at least for the 
 male population, a decided tendency towards a higher rate on the part 
 of the natives, but the data are not sufficient for entirely safe conclusions. 
 (Table XV, Appendix B.) They would seem to indicate, however, a lesser 
 disease liability on the part of the native Brazilians than on the part of 
 the foreign-born. The same conclusion applies to the relative frequency 
 by race, but in this case the fact must not be overlooked that the age dis- 
 tribution of the mixed population may possibly be much at variance with 
 the corresponding distribution of the pure white or black population. 
 (See table XVI, Appendix B.) * 
 
 *Under date of August, 1919, a report was issued to the eJFect that a new and model leprosarium 
 was under construction in Santo Angelo "which will be the best of its kind in all South America and 
 have all facilities for the isolation and treatment of lepers." Under date of January 10, 1920, the 
 American Medical Association, quoting from a Brazil medical periodical, states that a committee had reported: 
 "We question whether it is advisable to leave lepers in their homes under special surveillance or [not better] 
 to segregate them." Further directing attention to the beneficial results of segregation in Norway, where in 
 fifty-seven years the number had been reduced to less than three hundred cases. It is said that "In 
 Norway the central government has control over the whole country, and uniform methods of surveillance 
 could be applied." The report however, emphasizes that conditions in Brazil are very different, there 
 being no uniformity possible in the twenty states of Brazil under existing conditions. Hence "the con- 
 clusion that segregation is the only practical system for the prophylaxis of leprosy." But the committee 
 urges that the leprosariums should be easy of access to friends and attractive. 
 
 18 
 
Leprosy in Argentine Republic 
 Some very interesting statistics are also available for Argentina, where 
 a national conference on leprosy was held in Buenos Aires in 1906, when 
 the number of lepers throughout Argentina was returned as 724. Of this 
 number, 272 cases were found in the Province of Corrientes, 144 in the 
 Province of Buenos Aires, and 123 in the federal capital. Between 1906 
 and 1916 there were 350 cases of leprosy treated in the hospitals of the 
 Republic of Argentina.* 
 
 Leprosy in Venezuela 
 In Venezuela, so far as the death rate can be relied upon, there is 
 apparently a tendency towards a decline, for the highest rate, for 1905, 
 was returned as 31.0 per million of population, while by 1912 it had been 
 reduced to 22.5, and in 1918 to 9.8. In the meantime, however, the num- 
 ber of inmates at the leper asylum has not undergone a material change, 
 there being 666 cases in 1907, or 251.3 per million of population, against 
 582, or 211.2 per million, in 1912, and 753, or 262.5 per million, in 1918. 
 (See table XVII, Appendix B.)t 
 
 Leprosy in Barbados 
 Thus the evidence is quite sufficient to emphasize the conclusion that 
 leprosy in the Western Hemisphere is endemic and possibly on the in- 
 crease, and that therefore no country, and particularly no port of entry, 
 can be considered safe or inunune against the risk of a possible further 
 introduction of the disease into this country from nearby republics with 
 which our commercial relations are constantly expanding.^ The disease 
 prevails in Costa Rica, in Venezuela, on the west coast of South America, in 
 Dutch Guiana, and in practically all the West Indies, and particularly in the 
 island of Barbados, which is a source of considerable emigration to this 
 country. In Barbados the disease appears to be stationary, but evidence 
 is not wanting that lepers from Barbados have been apprehended in the 
 
 ♦According to the Journal of the American Medical Association for November 15, 1917, no successful 
 attempt is apparently made in Argentina to isolate all the lepers but it is planned "to construct a large 
 leprosarium with accommodations for five hundred patients in the Chaco district." The report protests 
 against an inland leper colony of this kind on the ground that "it is just adding fuel to the fire," and 
 suggests that "the leper colony should bo on some island apart from the centers of population and every 
 member should be given land. It should be a free farming community except that the inmates should not 
 be allowed to leave the island." 
 
 tThere are two leprosariums in operation in Venezuela. The largest is on the Isla de Providencia, 
 located just outside of the harbor of Maracaibo, with accommodations for seven hundred patients. . The 
 other is at Cape Blanco, about four miles from Lagiaira. 
 
 JThe most interesting statistics of leprosy are those available for certain provinces of India. Accord- 
 ing to the census of the Northwest Frontier Province there were three hundred and forty-four cases of 
 leprosy in 1881, diminishing to two hundred and seventy-six in 1891, increasing slightly to two hundred 
 and ninety-four in 1901 and diminishing again to two hundred and eighty-two by 1911. It is observed 
 in the return that "in the case of leprosy we could find no persistent tendency in any direction towards 
 an increase or a decrease in the frequency of the disease." But in this connection it is said that "it 
 is in the case of leprosy that the danger of wilful concealment is greatest, especially when the leper is 
 a female of respectable status." This would explain the lower ratio of women lepers almost invariably met 
 with where trustworthy data are available." It is pointed out that "errors of diagnosis no doubt detract 
 from the accuracy of the figures, for it is often difficult to distinguish leprosy from other diseases which 
 exhibit similar symptoms, such as leucoderma and syphilis." In this connection there may be quoted the 
 further observation that "The causes which predispose to the disease do not seem to have been 
 accurately determined; and no correspondence could be traced between the physical and climatic con- 
 ditions or between the race or the staple diets of the inhabitants of the tracts of India in which leprosy 
 was found to be especially common." (See appendix A and table XIX, Appendix B.) 
 
 19 
 
United States. During the period 1890-1917, 426 lepers have died in 
 Barbados, and of this number, 246 were males and 180 were females, an 
 overwhelming majority of the cases being of the tubercular variety, or 
 291 out of a total of 426. The average duration of treatment was longest 
 in the anesthetic type, or 9.6 years for males and 11.5 years for females; 
 but for the tubercular type the average length of treatment was only 4.5 
 years for males and 4.8 for females. The Barbados figures are of special 
 value in that, through the kindness of the authorities, I have been fur- 
 nished with a return in detail as to the causes of death, with distinction 
 of type, the facts being given in table XVIII, Appendix B, appended hereto 
 as an interesting contribution to a phase of the leprosy subject which has 
 heretofore, received totally inadequate consideration. In many of the discus- 
 sions of leprosy it is not clear whether the references are to lepers, or deaths 
 from leprosy. As shown by the Barbados returns, of the total number of 
 deaths of lepers from all causes, or 426, the number of deaths from causes 
 other than leprosy was 165, or 38.7 per cent. 
 
 National Conference on Leprosy in Argentina* 
 These considerations suggest the urgency of a much more qualified 
 and extended interest in the leprosy problem than prevails at the present 
 time. It is twenty-two years since the first leprosy conference was held 
 in Berlin, which was followed by the Bergen conference in 1909, and it 
 is nearly fourteen years since the great National Leper Conference was 
 held in the Argentine Republic. The report on that conference, by Dr. 
 Carlos G. Malbran, constitutes an invaluable source of trustworthy in- 
 formation amplified by interesting maps illustrating the relative frequency 
 of leprosy occurrence in the sections of the Argentine Republic most 
 affected by the disease. 
 
 Geographical Distribution in Brazil 
 Another valuable report on the geographical distribution of leprosy 
 in South America has been made by Dr. Carlos Da Costa Ribeiro under 
 date of May, 1918, to the Secretary of the Interior and Justice of Brazil. 
 This report includes a map illustrating the distribution of leprosy through- 
 out the State of Ceara for the year 1918, indicating the unsuspected fre- 
 quency occurrence of the disease, made even more suggestive by a map 
 of the city of Fortaleza, showing the distribution of existing cases through- 
 out the entire community. 
 
 Urgency of a Broader National Interest 
 Conferences and reports of this kind are in marked contrast to our own 
 indifference to a subject which should arouse the medical, general scien- 
 tific, and himianitarian interests in all who are concerned with problems 
 of health and human welfare. For a time the United States Public Health 
 Service published an important series of special reports on the results 
 
 ♦Conforenca Sobre la Lepra, Buenos Aires, 1908. 
 
 20 
 
of the work at the leprosy investigation station in Hawaii, but apparently 
 in recent years little has been done that is entitled to special consideration. 
 There is an immense mass of information which has not been subjected 
 to critical analysis or brought within the reasonable compass of a report 
 readily within the understanding of those who are seriously concerned 
 with the question as to whether the disease is actually on the increase in 
 this country and the enhanced risk of its introduction from abroad. 
 
 Recent Cases of Leprosy Throughout the United States 
 Without enlarging further, for the time being, upon the international 
 aspects of leprosy occurrence, there is presented here a smnmary statement 
 of the cases of leprosy reported in this country since April, 1916*. 
 
 This formidable list of about 250 cases can not be considered complete 
 or free from unavoidable duplications. The reports of the United States 
 Public Health Service give no indication whatever as to the personal facts 
 of most of the cases, so that one report can not be checked by another. It 
 would be very desirable if in every case the Public Health Service would 
 give the initials of the patient and, if possible, some very simple data as 
 to the nativity and racial origin, the age and sex, and the type of the 
 disease. 
 
 Urgency of a More Qualified Professional Interest 
 The reports emphasize the need of a better knowledge regarding the 
 diagnostic indications of leprosy if serious errors are to be avoided. 
 Reference may here be made to an article in the Brazilian Archives of 
 Medicine for November, 1918, on incipient leprosy, in which Mourao 
 described, with illustrations, what he calls "A New Sign of Leprosy," the 
 details of which are set forth in a brief article in the Journal of the 
 American Medical Association. If there is much need of better diagnosis, 
 there is the utmost urgency for a better understanding of the exact facts 
 of leprosy occurrence on the part of the general public. It is unfortu- 
 nately true that many of the cases reported are set forth in sensational 
 terms, causing undue alarm on the part of those who can not possibly be 
 expected to understand the essential facts of a disease which, fortunately, 
 is still of rare occurrence in this country. Conversely, however, there is 
 as much danger in underrating the importance of isolated cases, as, for 
 illustration, in the statement by the late surgeon-general of the United States 
 Public Health Service with reference to the Early case, that "though 
 leprosy is a disease to be dreaded it is not a national menace" in the same 
 sense that venereal diseases, etc., are, which, though true, leads neverthe- 
 less to erroneous conclusions on the part of the general public.f Leprosy- 
 is a serious menace to this nation and, however much guarded against by 
 modern methods of sanitary living and sanitary precautions, it is a danger 
 to any one and all who may have the misfortune to come in contact, know- 
 
 *Most of these cases are from the weekly Sanitary Reports of the United States Public Health Service. 
 tSee footnote on page 13. 
 
 21 
 
ingly or unknowingly, with patients suffering from the disease from its 
 incipient to its terminal stage. I can not do better than quote in this con- 
 nection from a cable despatch to the New York Sun, dated Honolulu, 
 November 11, 1919, a part of a pitiful story of a white woman recently 
 apprehended as a leper, and now, and probably for the remainder of her 
 life, at Molokai. This woman was the daughter of a former minister of 
 foreign affairs under King Kalakaua. She had been a leper since she was 
 five years of age, had been taken to Japan, but later on had been returned to 
 her mother's home, where she lived and was cared for until her mother's 
 death, when she was apprehended by the authorities and deported in 
 accordance with the law. Such cases occur every now and then in Hawaii, 
 clearly illustrating that the danger of disease transmission is not limited to 
 the lower class native element or to the foreign-born. 
 
 Cases of Leprosy in the United States Reported Since 1916 
 Location and Date Reported Remarks 
 
 Baltimore, Md., April 13, 1916. Dr. M. S. Rosenthal reported a colored boot- 
 
 black afflicted with leprosy at Mercy Hos- 
 pital. Included in his report is the state- 
 ment that, "This case well illustrates the urgent need of a national leprosarium, 
 where these unfortunates can find a permanent refuge and the community be 
 spared the presence of an unsightly, mutilated and incurable human being 
 awaiting the final call." 
 
 New Orleans, La., April 15, 1916. 
 April 29, 1916. 
 Lake End, La., April — , 1916. 
 Boston, Mass., April — , 1916. 
 
 New York City, May 6, 1916. 
 .Tune 3, 1916. 
 Mansfield, La., June — , 1916. 
 Minneapolis, Minn., June — , 1916. 
 
 rous symptoms began during 
 explosion in 1911. No history 
 
 San Francisco, Calif., July 15, 1916. 
 
 July 15, 1916. 
 Los Angeles, Calif., July 15, 1916. 
 White Fish, Mont., July — , 1916. 
 Boston, Mass., Aug. 11, 1916. 
 Bellingham, Wash., Aug. 19, 1916. 
 
 New Orleans, La., Aug. 19, 1916. 
 Yokohama, Japan, Aug. 22, 1916. 
 
 Galveston, Texas, Aug. 26, 1916. 
 Los Angeles, Calif., Aug. 26, 1916. 
 San Francisco, Calif., Sept. 2, 1916. 
 Sept. 30, 1916. 
 New Orleans, La., Sept. 30, 1916. 
 Oct. 7, 1916. 
 Seattle, Wash., Oct. 7, 1916. 
 
 One case. 
 
 Negro woman. 
 
 Native of Harput, Turkey. Sent to Penikese 
 
 Island. 
 
 One case; one death. 
 
 One death. 
 
 Colored male. 
 
 Chinese, native of Otage, Japan, in United 
 
 States nine years. Lived in Montana until he 
 
 came to Minneapolis, March 7, 1916. Lep- 
 convalescence from severe burn due to gasolene 
 of leprosy in patient's family. 
 
 American, had come from Denver four years 
 previously. Left for Louisville, Ky., June 7, 
 1916. 
 One case. 
 
 Chinese. 
 
 Cuban student, removed to Penikese Island. 
 
 A Greek who had been in the United States 
 
 more than three years. 
 
 Two cases reported. 
 
 Twenty-five cases of Americans ivith leprosy 
 
 reported in different parts of Japan. 
 
 One case. 
 
 Two cases. 
 One case. 
 
 22 
 
Location and Date Reported Remarks 
 
 New Orleans, La., Oct. 14, 1916. One case. 
 
 Milwaukee, Wis., Nov. 2, 1916. Greek. 
 
 Los Angeles, Calif., Nov. 11, 1916. One case. 
 
 New Haven, Conn., Nov. 20, .1916. Case reported by Dr. John E. Lane, con- 
 
 firmed by Dr. C. J. Bartlett, of the Yale Uni- 
 versity Medical School. It is said in this 
 connection that: "The chief interest in this case is the illustration of the fact 
 that leprosy patients wander about for a long time without being recognized, as 
 a majority of the physicians have never seen a case of the disease, and quite 
 naturally do not suspect it." 
 
 New Orleans, La., Nov. 25, 1916. 
 New York City, Nov. 25, 1916. 
 Newark, N. J., Dec. 2, 1916. 
 New York City, Dec. 2, 1916. 
 Ansonia, Conn., Dec. 9, 1916. 
 
 Indianapolis, Ind., Dec. 10, 1916. 
 
 San Francisco, Calif., Dec. 12, 1916. 
 Dec. 16, 1916. 
 Fort Branch, Ind., Dec. 21, 1916. 
 
 Williamsport, Pa., Dec. 30, 1916. 
 Oakland, Calif., Dec. — , 1916. 
 New Orleans, La., Dec. — , 1916. 
 San Francisco, Calif., Jan. 13, 1917. 
 Jan. 20, 1917. 
 New York City, Feb. 3, 1917. 
 Jersey Citv, N. J., Feb. 10, 1917. 
 New Orleans, La., Feb. 10, 1917. 
 Los Angeles, Calif., Feb. 10, 1917. 
 New Orleans, La., Feb. 17, 1917. 
 San Diego, Calif., Feb. 17, 1917. 
 
 Milwaukee, Wis., Feb. 21, 1917. 
 
 San Francisco, Calif., Feb. 24, 1917. 
 
 Jersey City, N. J., Feb. — , 1917. 
 
 New Orleans, La., (Parish) Feb. — , 1917. 
 
 March 3, 1917. 
 New York City, March 17, 1917. 
 San Francisco, Calif., March 24, 1917. 
 Springfield, Mass., May 10, 1917. 
 
 Richmond, Contra Costa Co., Calif., May 
 
 14, 1917. 
 Oakland, Calif., May 17, 1917. 
 Los Angeles, Calif., May 26, 1917. 
 New Orleans, La., May 26, 1917. 
 New York City, May 26, 1917. 
 Los Angeles, Calif., June 9, 1917. 
 Klamath Falls, Ore., June 14, 1917. 
 New York City, June 16, 1917. 
 Burtville, E. Baton Rouge Parish, La., 
 
 June — , 1917. 
 Los Angeles, Calif., July 13, 1917. 
 
 Collaborating Epidemi- 
 the Connecticut State 
 
 One case. 
 Two cases. 
 Syrian. 
 One case. 
 Case reported by 
 ologist Black, of 
 Board of Health. 
 
 Naval veteran of the Civil War. Case diag- 
 nosed by a young interne — Dr. C. V. Kemp 
 — at Long Hospital, who had never previ- 
 ously seen leprosy. 
 One case. 
 
 Native of Indiana, but formerly lived in 
 Alaska, Mexico, and Panama Canal Zone. 
 One case. 
 Three cases. 
 Two cases. 
 One case. 
 
 Mexican, transferred to Los Angeles County 
 
 Hospital. 
 
 One case. 
 
 Three cases notified during the month. 
 
 One case. 
 
 Syrian, who had escaped from City Hos- 
 pital, Newark, N. J., largely because of in- 
 adequate precautions and otherwise un- 
 suitable surroundings. 
 
 One case. 
 
 Chinese case. 
 
 Mexican. 
 
 Two cases. 
 
 One case. 
 
 Hawaiian case. 
 
 Italian, formerly living in Spokane. 
 
 One case. 
 
 Negro. 
 
 Japanese woman, resident for about one year. 
 
 23 
 
Location and Date Reported Remarks 
 
 Phillipsburg, N. J., July 17, 1917. Two cases, originally discovered on Black- 
 
 well's Island, N. Y. Children of a woman, 
 also a leper, whose cause of death had been 
 certified as embolism, although the symptoms were similar to those of the dis- 
 ease in the children. (See also Newark Evening News, April 12, 1918.) 
 
 Los Angeles, Calif., July 21, 1917. 
 New York City, July 26, 1917. 
 Syracuse, N. Y., Aug. 17, 1917. 
 
 White Pine County, Nev., Aug. 17, 1917. 
 Garyville, St. John Parish, La., Aug. — , 1917. 
 
 Providence, R. I., Sept. 14, 1917. 
 
 New Orleans, La., Sept. 29, 1917. 
 San Francisco, Calif., Oct. 13, 1917. 
 Biloxi, Miss., Oct. 18, 1917. 
 
 Alberton, Mont., Oct. 19, 1917. 
 San Francisco, Calif., Oct. 27, 1917. 
 Nov. 10, 1917. 
 New Orleans, La., Nov. 17, 1917. 
 Williamsport, Pa., Nov. 19, 1917. 
 
 Galveston, Texas, Dec. 1, 1917. 
 Bennettsville, S. C, Dec. 15, 1917. 
 Long Beach, Miss., Dec. — , 1917. 
 Jersey City, N. J., Jan. 30, 1918. 
 
 Portland, Ore., Feb. 9, 1918. 
 New Orleans, La., Feb. 16, 1918. 
 Feb. 23, 1918. 
 Jersey City, N. J., Feb. 25, 1918. 
 
 One case. 
 
 Greek, who came to United States in 1913. 
 Two cases reported, brothers, natives of 
 Greece, formerly residents of New York 
 City. (One of these escaped August 15, be- 
 cause of inadequate precautions.) 
 One case. 
 
 Father and three brothers of this patient had 
 previously been sent to the State Lepers 
 Home. 
 
 Native of Italy, resident of this country five 
 years. 
 One case. 
 
 This man was employed as oyster shucker 
 when discovered, having followed that occu- 
 pation for past six years. 
 One case. 
 
 Sicilian, in United States eleven years. 
 Isolated outside of city. 
 One case. 
 
 Native and former resident of Louisiana. 
 Native of Germany, formerly a resident of 
 Brooklyn, who died by suicide day following. 
 One case. 
 
 Negro woman from West Indies. This was 
 the third case for some time past reported to 
 local authorities, one having been a Mexi- 
 
 can, and second case, also apparently a foreigner, who committed suicide. 
 
 West Haven, Conn., Feb. — , 1918. 
 Galveston, Texas, March 2, 1918. 
 Oakland, Calif., March 2, 1918. 
 New Orleans, La., March 9, 1918. 
 
 March 13, 1918. 
 
 March 23, 1918. 
 Los Angeles, Calif., March 23, 1918. 
 San Francisco, Calif., March 23, 1918. 
 Los Angeles, Calif., April 9, 1918. 
 April 13, 1918. 
 San Francisco, Calif., April 20, 1918. 
 Riverside, Calif., April 23, 1918. 
 Louisville, Ky., April 27, 1918. 
 Philadelphia, Pa., April 29, 1918. 
 Boston, Mass., May 7, 1918. 
 New Orleans, La., May 25, 1918. 
 Rio Vista, Calif., May — , 1918. 
 
 One case. 
 
 One death. 
 
 Native East Indian. 
 
 One case. 
 
 Native Hawaiian, age 
 
 the islands 3^ years. 
 
 14; had lived in 
 
 24 
 
Location and Date Reported 
 Fresno, Calif., May — , 1918. 
 
 San Francisco, Calif., May — , 1918. 
 
 Abilene, Texas, June 8, 1918. 
 Bridgeport, Conn., June 8, 1918. 
 New Orleans, La., June 8, 1918. 
 June 29, 1918. 
 Alexandria, La., June 29, 1918. 
 Boston, Mass., June 29, 1918. 
 June — , 1918. 
 
 Bridgeport, Conn., June — , 1918. 
 
 Avoyelles Parish, La., June - — , 1918. 
 
 Oakland, Calif., July 13, 1918. 
 July 27, 1918. 
 Mandeville, La., July — , 1918. 
 New Orleans, La., July — , 1918. 
 Oakland, Calif., July — , 1918. 
 
 Boston, Mass., July — , 1918. 
 
 New Orleans, La., Sept. 21, 1918. 
 Sept. 28, 1918. 
 Dayton, Ohio, Sept. — , 1918. 
 Tyron, N. C, Sept. — , 1918. 
 
 Boston, Mass., Oct. 29, 1918. 
 Glendale, Ariz., Oct. — , 1918. 
 Boston, Mass., Nov. 2, 1918. 
 Galveston, Texas, Nov. 2, 1918.. 
 New York City, Nov. 9, 1918. 
 New Orleans, La., Nov. 13, 1918. 
 Nov. 16, 1918. 
 Los Angeles, Calif., Dec. 21, 1918. 
 Feb. 2, 1919. 
 Braddock, Pa., Feb. — , 1919. 
 New Orleans, La., March 8, 1919. 
 San Francisco, Calif., March 8, 1919. 
 Philadelphia, Pa., March 15, 1919. 
 District of Columbia, March — , 1919. 
 
 Galveston, Texas, April 19, 1919. 
 
 Philadelphia, Pa., April 21, 1919. 
 
 New Orleans, La., April 26, 1919. 
 San Francisco, Calif., April 26, 1919. 
 April — , 1919. 
 
 Remarks 
 Two cases; one a native woman of Mexico, 
 and one a Chinaman, of Louisiana. 
 Chinaman, resident in United States eight 
 years. 
 One case. 
 
 Two cases. One a native of China, and one 
 
 a Russian. 
 
 Greek, resident of United States for past 
 
 four years. 
 
 One case. Transferred to Louisiana State 
 
 Leper Colony. 
 
 One case. 
 
 Two cases. 
 
 One case. 
 
 Two cases. Chinamen; natives of Hawaii, 
 possibly previously reported from other lo- 
 calities. 
 
 Two cases. One from nearby state, sent to 
 Penikese Island. 
 One case. 
 Two cases. 
 
 Greek, formerly resident of Columbus, Ohio. 
 Famous Early case. Early had escaped from 
 Washington, D. C. 
 Native of Cape Verde Islands. 
 Native Mexican. 
 One case. 
 
 One death. 
 One case. 
 
 Native of Philippine Islands. 
 One case. 
 
 One case. Patient died of smallpox, March 
 22, 1919. 
 
 White woman, life-long resident of Galves- 
 ton. 
 
 Syrian, reported as having disappeared, 
 probably with intention to reach New York. 
 Peddler, apparently same case as reported 
 from Springfield, Mass., and Newark, N. J. 
 One case. Died. 
 
 Native Californian who had never been out- 
 side the State, being one of three cases 
 known to have been contracted, without 
 question, in California. Case reported by Dr. Howard Morrow, of San Francisco. 
 Stockton, Calif., April — , 1919. Native of Stockton, whose brother is sus- 
 
 pected of being a leper, and whose father 
 had leprosy at the time of his death in 1912. 
 
 25 
 
Location and Date Reported 
 Hartford, Conn., April — , 1919. 
 
 New Orleans, La., May 3, 1919. 
 New York City, May 3, 1919. 
 Philadelphia, Pa., May 3, 1919. 
 Portland, Ore., May 3, 1919. 
 Monte Rio, Calif., May 4, 1919. 
 San Francisco, Calif., May 8, 1919. 
 Boston, Mass., May 10, 1919. 
 New York City, May 10, 1919. 
 San Francisco, Calif., May 10, 1919. 
 Boston, Mass., May 24, 1919. 
 San Francisco, Calif., May — , 1919. 
 El Centro, Calif., May — , 1919. 
 San Francisto, Calif., June 7, 1919. 
 Los Angeles, Calif., June 10, 1919. 
 June 14, 1919. 
 Baltimore, Md., June 14, 1919. 
 New Orleans, La., June 21, 1919. 
 Philadelphia, Pa., June 21, 1919. 
 Orleans Parish, La., June — , 1919. 
 St. Martin Parish, La., June — , 1919. 
 Contra Costa County, Calif., June — , 1919, 
 New Orleans, La., July 12, 1919. 
 Boston, Mass., July 14, 1919. 
 
 San Francisco, Cailf., July 26, 1919. 
 July — , 1919. 
 Santa Rosa, Calif., July — , 1919. 
 LaFayette, La., July — , 1919. 
 Olympia, Wash., July — , 1919. 
 New Orleans, La., Aug. 2, 1919. 
 Sacramento, Calif., Aug. 16, 1919. 
 San Francisco, Calif., Aug. 16, 1919. 
 Lansing, Mich., Aug. 30, 1919. 
 
 New York City, Aug. — , 1919. 
 Galveston, Texas, Aug. 30, 1919. 
 Otero County, Colo., Aug. — , 1919. 
 Beloit, Wis., Sept. 6, 1919. 
 Benton Harbor, Mich., Sept. 6, 1919. 
 Los Angeles, Calif., Sept. 6, 1919. 
 New York City, Sept. 13, 1919. 
 New Orleans, La., Sept. 13, 1919. 
 Los Angeles, Calif., Sept. 27, 1919. 
 San Francisco, Calif., Sept. 27, 1919. 
 Oct. 4, 1919. 
 Los Angeles, Calif., Oct. 11, 1919. 
 Houston, Texas, Oct. 18, 1919. 
 Boston, Mass., Nov. 1, 1919. 
 Los Angeles, Calif., Nov. 1, 1919. 
 New York City, Nov. 1, 1919. 
 Pueblo, Colo., Nov. 1, 1919. 
 New Orleans, La., Nov. 8, 1919. 
 San Francisco, Calif., Nov. 8, 1919. 
 Ann Arbor, Mich., Nov. 13, 1919. 
 Los Angeles, Calif., Nov. 22, 1919. 
 New Orleans, La., Nov. 22, 1919. 
 Charlotte, N. C, Nov. 29, 1919. 
 
 Remarks 
 Native of Trinidad, West Indies, formerly 
 resident of Providence and Boston. 
 One case. 
 
 Chinaman, born in San Francisco. 
 
 Mexican. 
 
 One case. 
 
 Two cases and one death. 
 
 One case. 
 
 (Patient escaped to Mexico.) 
 
 One case. 
 One case. 
 Mexican. 
 One death. 
 
 One case. 
 One death. 
 Two cases. 
 One case. 
 
 Case reported of a leper who escaped from 
 the Detention Hospital, subsequently appre- 
 hended in Philadelphia. 
 One case. 
 Mexican male. 
 
 Formerly resident of Hawaii. 
 One case. 
 
 One case. Formerly U. S. soldier who had 
 been in service in Philippines. 
 One case. 
 
 One death. 
 
 One case. 
 
 Native of Porto Rico. 
 
 One case. 
 
 One case; one death. 
 
 One case. 
 
 Two cases. 
 One case. 
 
 One death. 
 One case. 
 
 One death. 
 
 One case. 
 Two cases. 
 One case. 
 
 26 
 
Location and Date Reported Remarks 
 
 St. Joseph, Mo., Nov. 29, 1919. One case. , r^ r^ 
 
 Cambridge, Wis., Nov. — , 1919. Second case reported in State, by Ur. Cor- 
 
 nelius A. Harper, of Madison. 
 Chicago, 111., Nov. — , 1919. One case. 
 
 Pinos Altos, N. M., Nov. — , 1919. 
 La Junta, Colo., Dec. 6, 1919. Mexican. 
 
 Galveston, Texas, Dec. 6, 1919. One death. , . x 
 
 Ann Arbor, Mich., Dec. 13, 1919. One case. (Possibly previously given.) 
 
 Christiana Wis., Dec. — , 1919. One death. (Originally diagnosed June 3, 
 
 1919.) 
 Boston, Mass., Jan. 22, 1920. One case, formerly of Rome, N. Y. Worker 
 
 in chocolate factory. 
 Tilden, Neb., Jan. 29, 1920. Spanish War veteran. 
 
 Boston, Mass., Jan. 31, 1920. Second case reported withm fortnight; ce- 
 
 ment worker from Baltimore ; sent to i eni- 
 kese Island. 
 San Francisco, Calif., Jan. 31, 1920. One case. , ^, , , ^ . 
 
 Dayton, Ohio, Feb. 29, 1920. According to the Cleveland Leader, case 
 
 being cared for at present time at Day- 
 ton. A Greek, whom it is proposed to re- 
 turn to his native country. Stated in same dispatch that there had been a leper 
 in same locality — Mexican— who had escaped several months ago. 
 New York City, March 7, 1920. According to Bronxborough Netvs of March 
 
 7th there are at present time 22 cases of 
 known leprosy in New York City, subject to 
 practically no restrictions or supervision, being allowed to walk about the streets 
 of the city on the assumption that "the disease can not develop in this climate. 
 This, of course, is a serious error, for leprosy develops in any climate and under 
 any conditions of life, as far as known, where there is exposure to existing cases, 
 or contact, since the disease is known to be transmissible, although the exact 
 method of transmission remains a mystery.* 
 Muskogee, Okla., March 13, 1920. A negro suspect escaped from Coffeyville, 
 
 Kans., was apprehended by local health 
 authorities. 
 Lansing, Mich., March 26, 1920. One case. Native of Lansing. 
 
 New Orleans, La., April 15, 1920. Two cases. Found by city health officials 
 
 while awaiting "treatment" at the hands ot 
 a faith healer. 
 
 Need and Value of a National Leprosy Conference 
 The preceding list of cases should arouse the interest of an indifferent 
 public, an indifferent medical profession, and a public health service far 
 from being as active as the needs of the present situation demand. Whether 
 leprosy is actually on the increase or not is secondary to the question that 
 the disease occurs with a sufficient degree of frequency throughout prac- 
 tically the whole United States to demand a change from public apathy, 
 little short of a crime. Other countries, in which a much lesser number of 
 cases occur, make adequate provision and render adequate reports with a 
 reasonable assurance that measures of control are more effective than they 
 are apparently in this country at the present time. The example of Argen- 
 tina may well be followed in this country, for only a national conference 
 thoroughly representative of all the interests concerned can arouse the 
 American public to a danger that confronts future generations if new 
 endemic centers are allowed to be created. It is not a problem for a 
 
 ♦The actual number of cases in New York City at the present time i« 28. 
 
 27 
 
city or a State to solve, but a matter of the utmost national and interna- 
 tional concern. Much good unquestionably resulted from the international 
 leprosy conferences of 1897 and 1909, and a similar conference called at 
 the present time, even if limited to the Pan-American republics, would 
 unquestionably prove productive of far-reaching results. But if such a 
 congress could be made inclusive at least of the countries of the Far East, 
 and if held in the United States, tlie best thought of the present day would 
 be concentrated upon an agreement as to the course of procedure likely 
 to prove most advantageous to the patient and the public directly concerned. 
 
 I may in this connection direct attention to a remarkable address 
 on "Leprosy: A New View of Its Bacteriology and Treatment," by T. S. 
 Beauchanfp Williams, M.D., contributed to the Indian Medical Gazette 
 for May, 1911, as an illustration of much neglected phases of the subject 
 in this country. At the same time, I may recall an excellent outline of 
 fundamental principles, by Dr. Isadore Dyer, set forth in an address on 
 "The Dermatologic Aspects of Leprosy," contributed to the proceed- 
 ings of the Sixty-fourth Annual Session of the American Medical Asso- 
 ciation in 1913. Two years later Dr. Douglass W. Montgomery read an 
 important address on "Illustrations of the History of Leprosy," in the sec- 
 tion on dermatology, of the American Medical Association, San Francisco, 
 1915, and many of those present were given the privilege of observing 
 actual cases of leprosy, brought down to the meeting from the Isolation 
 Hospital of the city. The paper by Dr. Montgomery was increased in value 
 by a report of cases with observations on "Symptoms and Diagnosis of 
 Leprosy," by Dr. Howard Morrow and Dr. A. W. Lee, of San Francisco, 
 clearly illustrating that in its scientific aspects the disease is not being 
 neglected in this country. Nor must I omit to refer by title to an address 
 on "The Etiology and Treatment of Leprosy," by Dr. Ernest Dwight Chip- 
 man, read at the same meeting, which will always represent a milestone 
 in the progress of the study of a subject which, on account of the rarity 
 of the disease, is perhaps one of the most diflfiicult problems of modern 
 medicine. 
 
 Medical and Dermatological Aspects of Leprosy 
 
 Regardless of the advances which have been made during recent years, 
 we are still far behind in the adequate consideration of questions of 
 etiology, diagnosis, and treatment based upon the actual experience which 
 has been had in this coimtry and which unquestionably, in important mat- 
 ters of detail, differs from the experience in large endemic leprosy centers 
 abroad. This point of view is perhaps best illustrated by reference to the 
 extremely interesting report on the treatment of leprosy, by Dr. F. Hall, 
 superintendent of the leper asylum at Makogai, Fiji Islands, and the 
 admirable statistical analysis of 10,000 cases of leprosy at the Culion 
 Leper Colony, Philippine Islands, by Dr. Oswald E. Denney. This paper 
 is of special interest if read in connection with the observations on the 
 treatment of leprosy in the Philippine Islands, by Dr. Victor G. Heiser, 
 
 28 
 
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formerly the director of health and a surgeon of the United States Public 
 Health Service (1914). The scientific study of the subject would be very 
 much enhanced if more detailed reports were made of the cases under 
 observation throughout the country, but particularly in the larger centers 
 like Louisiana, Massachusetts, California, and Molokai. The best illustra- 
 tions of the proper method of reporting on existing cases are the annual 
 reports on leprosy in New South Wales, including an annual review 
 with observations of all cases at the colony at Little Bay since 1883. Such 
 a tabular analysis for Hawaii would make an extremely interesting con- 
 tribution to knowledge and possibly aid in the solution of a problem which 
 thus far has failed to meet the exacting requirements of modern scientific 
 research. iThe New South Wales reports give tlie name (by initials), the 
 sex, nativity, occupation, date of, and age on admission, locality where 
 disease was probably contracted, number of the case, clinical notes, and 
 the date of death or discharge. The clinical notes describe in detail, 
 though with the required brevity, the history of the illness, the conditions 
 on admission, differentiating the parts of the body, and finally, notes on 
 the progress of the disease and the treatment, presenting in brief a rea- 
 sonably complete picture of the cases under treatment, amplified by notes 
 on the examinations of material for leprosy bacilli carried out by the 
 microbiological laboratory of the department of public health. 
 
 Present Status of the Federal Leprosarium 
 It would be utterly impossible to attempt, within the necessary limita- 
 tions of time, the presentation of the essential facts of leprosy occurrence 
 throughout the world, although an abundant amount of extremely valuable 
 material is available for the purpose. The hope that the leprosy investi- 
 gations at the United States station at Molokai would very materially 
 increase our knowledge of the disease from its incipient to its advanced 
 stage has not been realized. But even more lamentable is the long delay 
 in the establishment of a federal leprosarimn in accordance with the act 
 of Congress of February 3, 1917, although it may be said that the outlook 
 at the present time is somewhat more hopeful that such an institution will 
 shortly be established, though possibly not in a locality entirely suitable 
 for the purpose. 
 
 I am able to conclude this address with a letter from the Acting Sur- 
 geon General of the United States Public Health Service, dated March 10, 
 1920, who in answer to an inquiry as to the present status of the leprosarimn 
 question, replied as follows: 
 
 "In reply to your letter oi March Sth requesting information as to the present 
 status of the Federal Home for Lepers, I have the honor to inform you that the Board 
 hopes to begin construction within a short time. As you know, the Surgeon General 
 appointed a Board of which you were a member to assist in the selection of a site. 
 TTiis Board made a careful and comprehensive survey of all available sites in all 
 sections of the United States and decided that the best and most suitable site for the 
 Federal Leprosarium would be on the three islands known as Snake Key, North Key 
 and Sea Horse Key, lying in the Gulf of Mexico off Cedar Keys, Florida. The Board 
 
 30 
 
80 recommended to the Surgeon General who approved their findings and forwarded 
 them to the Secretary of the Treasury with a request that the transfer of these three 
 islands be requested from the Department having jurisdiction. In accordance with 
 the request of the Secretary of the Treasury the Secretary of War on September 5th 
 transferred Snake Key and North Kev for the purposes of a leprosarium disclaiming 
 jurisdiction of Sea Horse Key ^vhich had been set apart for light house purposes on 
 September 25, 1851, and was therefore under the jurisdiction of the Department of 
 Commerce. A Department letter addressed to the Secretary of Commerce asking for 
 permission to use and occupv Sea Horse Key for the proposed Federal Home for 
 Lepers was favorably answered by the Secretary of Commerce on September 19, 1919 
 
 "As might be expected the selection of a site for a leprosarium in any state would 
 develop some opposition. The entire Florida delegation accompanied the Governor 
 of Florida in a \isit of protest to the Surgeon General on October 23rd, 1919. The 
 opposition locally, however, is largely the development due to the activity of one man, 
 and through a very active propaganda instituted by him throughout the state. 
 
 "Since that time Government representatives have been able to present the facts 
 to the people of Florida and a very strong sentiment has developed for the establish- 
 ment of the leprosarium on the site named above. _ _ 
 
 "Owing to the popular fallacy concerning the danger of leprosy it is not to be 
 expected that less opposition will he encountered in any state and in all probabilities 
 the Department will go ahead -^vith the construction of the Federal ^Home for Lepers 
 upon the three keys named in the vicinity of Cedar Keys, Florida." 
 
 Importance of Accurate and Complete Leprosy Statistics 
 The question of leprosy increase and the adequate federal care and 
 proper treatment of lepers is, therefore, one of the near future, being 
 largely dependent upon an aroused public, professional and governmental 
 interest. Leprosy at the present time may possibly have reached a more 
 or less stationary condition in this country, but it is not to the credit of 
 our civilization that the frequency of the disease should not be actually 
 on the decrease. The apparent increase can not be charged exclusively to the 
 foreign element, which can not if leprous be kept out by even the most rigid 
 quarantine examination, but, as shown by the experience in Louisiana, 
 for at least one hundred years, the disease has gradually been gaining in 
 frequency until a number of endemic centers now exist as to which the 
 public at large is rightfully entitled to more trustworthy information than 
 is at present available. According to the reports received from health 
 officials all over the country, there are at present not less than eighty-seven 
 cases in Louisiana, thirty-nine cases in California, thirteen cases at the 
 Penikese Colony of the State of Massachusetts, twenty-eight cases in the 
 city of New York, five cases in Connecticut, ten cases in Minnesota, and 
 thirty-three cases in Texas. There are sufficient reasons for believing that 
 the number of known cases probably represents less than one-half of the 
 actual number of cases in this country at the present time, and, restating 
 the estimate previously arrived at, which unquestionably falls short of the 
 whole truth, the probable number of cases of leprosy in this country at 
 the present time is not less than 400. The situation is therefore a most 
 serious one, which it is the duty of the Government to consider with a 
 lesser degree of indifference than has been the case in the past, and more 
 so in view of the liberality of Congress in providing adequately for the 
 establishment of one federal leprosarium, which it is hoped will in time 
 
 31 
 
be followed by two or three others, as the only hope of dealing effectively 
 with the question of proper segregation and control. It is the firm belief 
 of those who are best in a position to judge, that only by means of such 
 segregation can the frequency of the disease be reduced — at least this has 
 been the experience at Tracadie in New Brunswick, at Bergen in Norway, 
 and at Molokai in Hawaii. Nothing could be more wrongful than to arouse 
 an unnecessary alarm on the part of the general public, for the actual 
 danger of an extensive spread of the disease is slight, but whoever has seen 
 even one case of leprosy, and I personally have seen more than two thou- 
 sand, can not but feel a sense of profound personal obligation that noth- 
 ing should be left undone so that this most unfortunate element of our 
 population may be better cared for in a medical as well as in a humane 
 sense, than is the case, unhappily, at the present time. 
 
 Summary of Conclusions 
 
 On the basis of the best possible information it may therefore be con- 
 servatively estimated that there are not less than 250 known cases, and 
 probably from 400 to 500 known and suspected cases of leprosy throughout 
 the continental United States at the present time. 
 
 This estimate is more conservative than earlier assimiptions, but the 
 available evidence would seem to justify the conclusion that the disease is 
 very slowly increasing in this country and that new foci of leprosy are 
 being formed and as such constitute a serious menace to the public health 
 interests of the nation as large. 
 
 Under date of February 3, 1917, or more than three years ago, Con- 
 gress enacted a bill providing the sum of $250,000 for a federal lepro- 
 sarium, chiefly for the care of interstate and international lepers. It is 
 regrettable that there should have been so much delay in establishing a 
 model federal institution, but the outlook seems fairly hopeful that the 
 site selected at Cedar Keys, Florida, will meet with public approval. 
 Whether it is the best site that could have been selected is open to question. 
 
 It was recommended that the Government use the Ship Island quaran- 
 tine station, which has been abandoned for other purposes, and could have 
 been utilized at very small expense practically for the immediate accom- 
 modation of isolated cases of leprosy throughout the South. The question 
 is pertinent why such a site, in all respects admirable for the purpose, 
 should go to waste when the situation is most urgent and in fact in some 
 cases a desperate one. 
 
 The first leper home in this country was established by the State of 
 Louisiana in 1894 near Carville, on the Yazoo and Mississippi Valley Rail- 
 way, near a point in Iberville Parish, La., known as Bruns, about sixty 
 miles from New Orleans. That institution has about one hundred inmates 
 and is under the medical supervision of Dr. Ralph Hopkins, of New Orleans, 
 and a board, of which Dr. Isadore Dyer is a member. 
 
 At the Louisiana institution about eighty per cent, of the lepers cared 
 
 32 
 
for are white, whereas the white population of the State is only fifty-seven 
 per cent. Whether this would justify the conclusion that leprosy is rela- 
 tively more common among the white than among the colored population 
 is somewhat doubtful, for negro cases are probably more effectively 
 secreted than white cases. 
 
 The average age on admission was thirty-two years for white males 
 and forty years for colored males. For females the average age on admis- 
 sion was thirty-seven years for white patients and thirty-eight years for 
 colored patients. It would therefore seem fairly safe to conclude that the 
 average age on admission is somewhat higher for colored lepers than for 
 white lepers. 
 
 Of the total number of cases now under observation at the Louisiana 
 Home, about thirty per cent, are of the tubercular variety, twenty-four per 
 cent, of the anesthetic variety, and thirty-seven per cent, of the anesthetic 
 and tubercular varieties combined. 
 
 The age period of greatest frequency on admission was 20-29 years. 
 
 The average length of treatment previous to death is from about eight 
 to ten years. The duration varies with different types of the disease, being 
 longest in anesthetic cases and shortest in tubercular cases. 
 
 For most of the elements of the leprosy problem the data are only 
 gradually becoming available. In the report of the Senate Committee on 
 Public Health and National Quarantine is included a large amount of 
 international information, some of which has been brought down to date 
 for the present purpose and is included in Appendix B to this address. 
 
 Unfortunately our information regarding leprosy in the States in 
 which the disease is fairly cornmon is far from complete. According to 
 the most trustworthy recent returns the number of known ca.ses of leprosy 
 in Louisiana is eighty-seven; in California, thirty -nine; in Massachusetts, 
 thirteen; in Minnesota, ten; in New York City, twenty-eight; in the State 
 of Pennsylvania, six; in Texas, thirty-three; while isolated cases are known 
 to occur in probably ten to fifteen more States at the present time. 
 
 In the registration area, which now includes about eighty per cent, of 
 the total population of the United States, there have occurred during the 
 last ten years 120 deaths from leprosy. The recorded mortality rate has 
 increased from 0.13 per million in 1900 to 0.29 in 1918. If the death 
 rate of 1918 is taken as 0.3 per million, the number of probable cases in 
 the continental United States may be conservatively placed at 400. This 
 does not represent the cases officially noted during the lifetime of all the 
 lepers, or effectively segregated, or subject to government supervision and 
 control, but rather the assumed number of cases which give rise to the 
 mortality indicated on the basis of the probable known death rate of 
 lepers under segregation, placed as high as 80 per 1,000 per annum. 
 
 The discussion includes a statement in detail of nearly 250 reported 
 cases of leprosy throughout the continental United States during the period 
 April, 1916, to April, 1920. The list clearly emphasizes the menace to 
 the American nation of a deplorable attitude of public apathy and neglect. 
 
 33 
 
It was the evidence presented to the Senate Committee on Public Health 
 and National Quarantine which resulted in the passage of a bill providing 
 for a federal leprosarium. One institution will meet an emergency but will 
 only in part aid in the solution of the problem. Three institutions are cer- 
 tainly required, and possibly four; there should be one on the Gulf Coast, 
 one on the Pacific, one on the Atlantic, and one in the Central West. The 
 institutions now maintained by the State of Massachusetts at Penikese 
 Island, Buzzard's Bay, by the State of Louisiana, by the City of San 
 Francisco at the Isolation Hospital, and by certain other commimities in 
 connection with public institutions, meet only the most urgent needs of a 
 situation not far from desperate. It is to be hoped that the Public Health 
 Service wilj more actively concern itself in the future with the provision 
 of the act of Congress, which, though not mandatory, is certainly equiva- 
 lent to a request that all unnecessary delay should be avoided. 
 
 There is leprosy to the north of us in New Brunswick and British 
 Columbia; there is leprosy to the south of us in the West Indies and Cen- 
 tral America, the Panama Canal Zone, and throughout a large portion of 
 South America; there is leprosy to the east of us in European countries 
 such as Greece, Bulgaria, Syria, Scandinavia, Northeast Germany, Russia, 
 Turkey, etc. ; and there is leprosy on an immense scale to the west of us in 
 Hawaii, the Philippines, Japan, and throughout the farther East. Only a 
 grossly indifferent public opinion can account for our national apathy 
 towards a question which has been a subject for discussion in the medical 
 press and otherwise for over fifty years. There are perhaps one hundred 
 cases in the Panama Canal Zone, there are over six hundred cases in 
 Hawaii, there are over five thousand cases in the Philippines, and through- 
 out the world possibly not less than three million cases, a potential menace 
 at least to every other country indifferent to its interest and in our own case 
 from the fact that leprosy in the United States occurs often in isolated in- 
 stances, one and all of which can be traced to some locality where leprosy 
 is known to exist. 
 
 It may therefore be suggested that this question should receive more 
 adequate consideration in the future and that pressure should be brought 
 to bear upon the public health authorities, the Federal Government, and 
 the several States to deal more effectively and humanely with leprosy 
 cases now known to occur. It may further be suggested that the time is 
 opportune for another leprosy conference in continuation of the inter- 
 national meetings held in Berlin in 1897 and in Bergen, Norway, in 
 1909, and of the corresponding national conference held in the Argentine 
 Republic in 1906."' Such a conference would bring together the best thought 
 of the present period in behalf of the solution of a problem which is an 
 indictment of our civilization and most of all of our indifference to the 
 humane interests and the personal welfare of the most afflicted portion of 
 mankind. 
 
 ♦For important observations on previous leprosy congresses see the Journal of the American Medical 
 Association, April 4, 1896, February 20, 1897, and November 13, 1897. Also the report by Sir Arthur 
 Newsholme and Sir Malcolm Morris at the International Conference of 1909. (Parliamentary paper, Cd. 
 4916, London, 1909, P. S. King & Son, London.) 
 
 34 
 
APPENDIX A 
 Leprosy in India 
 
 There is no more fruitful field for the statistical study of leprosy than 
 the vast Indian Empire, for which admirable census reports have been 
 published for a long period of time. These reports amplify the large 
 amount of useful information contained in the report of the Leprosy Com- 
 mission (Calcutta, 1893). According to the census of India for 1911 (Cal- 
 cutta, 1913) the proportion of lepers to population was 50 males and 18 
 females per 100,000 of each sex. Of the different provinces of India, 
 Assam suffers most, then Burma, then, in order, Bihar and Orissa, the 
 Central provinces and Berar, Madras, Bengal, Bombay, the United pro- 
 vinces, the Punjab, and the Northwest Frontier provmces. In the last two 
 provinces the proportion of lepers was 17 males and 8 females per 100,000 
 of population of each sex. It is observed in the report referred to that 
 "the physical and climatic characteristics of the tracts where leprosy is 
 most prevalent differ greatly. In some of these tracts the climate is dry 
 and the rainfall light, while others have a damp climate with heavy rain- 
 fall. Some of them are alluvial river valleys, while others have a laterite 
 or rocky soil. Some are low-lying, others are slightly elevated, and others 
 again are in mountainous country. The races who inhabit these areas also 
 vary greatly, and they subsist on different kinds of food." 
 
 Throughout India the ratio of male lepers is far in excess of the cor- 
 responding ratio of females. It is pointed out, however, that while it is 
 possible that males are more susceptible to the disease than females, it is 
 very improbable that this is the case to the extent indicated by the census 
 figures. For it is held that "the great disproportion which they show is 
 no doubt due largely to the fact that the disease is concealed wherever 
 possible, and that women are more successful than men in evading the 
 inquisitiveness of the enumerators." As regards the incidence of age, it 
 is stated that "imder the age of 10 the proportion of lepers is exceedingly 
 small, but it soon begins to grow. There is a considerable increase be- 
 tween 10 and 20; and from that age up to 50 the rise is uniform and 
 fairly rapid. Between 50 and 60 the proportion continues to increase 
 slightly, and then declines. Bearing in mind the fact that a leper's life is 
 a comparatively short one, it would seem that the greatest liability to the 
 disease occurs between the ages 20 and 50." 
 
 The occurrence of leprosy according to caste is an extremely complex 
 problem which cannot be dealt with briefly on account of the (to us) practi- 
 cally meaningless designations of castes for which there is no equivalent in 
 English-speaking countries. Those who care to examine into the subject from 
 this viewpoint should consult the handbooks for the Indian army describ- 
 
 35 
 
ing the different principal castes in India, published by the government 
 printing office, Calcutta. It is stated in the census report for 1911 that 
 "the low castes suffer more from leprosy than the high." This greater 
 liability-, it is explained, of the lower castes, "may be ascribed to their 
 povertv, and to the small, insanitary, and often dirty, houses in which they 
 live." But it is pointed out in this connection, "it must be remembered 
 that successful attempts at concealment are probably more frequent in the 
 case of the higher castes. The proportion of Christians among lepers is 
 exceptionally high, but this is simply because most of the asylimas are 
 managed by missionary bodies, who make many converts amongst the 
 unfortimate inmates." 
 
 The number of lepers throughout India has decreased from 126,000 
 in 1891 to 109.000 in 1911, a diminution equivalent to more than 13 per 
 cent. This decrease, it is maintained, is genuine and indicative of a real 
 diminution in the prevalence of the disease. It is pointed out, however, 
 that this is "partly the result of the improved material condition of the 
 lower castes, amongst whom leprosy is most common, and of a higher 
 standard of cleanliness." 
 
 The total number of leper settlements or asylums in India, according 
 to the census of 1911, was then 73. But these contained only some 5,000 in- 
 mates, or not quite five per cent, of the total number of lepers. The report 
 concludes with the following interesting observation: 
 
 "The belief is growing that leprosy is communicated from one human being 
 to another bj' some insect, and two South African doctors have recently pub- 
 lished papers implicating the bed bug (acanthia lectularia) . If this theory be 
 correct it is ob'sious that the segregation of lepers in asylums must reduce the 
 number of foci of the disease, and to that extent prevent it from spreading. It 
 is worthy of note that in many of the districts where the disease was most 
 prevalent in 1891, there has since been a remarkable improvement. Chamba, 
 which in 1891 had 34 lepers in everj' ten thousand of its population, now has 
 only 15; in Birbhum the corresponding proportion has fallen from 36 to 16, in 
 Banlcura from 36 to 23. in Simla from 29 to 18, in Dehra Dun from 20 to 11, 
 in Garhwal from 17 to 10. in Burdwan from 22 to 14. and in North Arakan 
 from 28 to 20." 
 
 These general observations on the occurrence of leprosy throughout 
 India are enlarged upon in the separate census reports for the several 
 provinces. 
 
 Referring first to the province of Assam (Shillong, 1912), it appears 
 that the local rate of incidence varies between a minimum of less than 5 
 per 100,000 of population to a maximum of from 85 to 90. The report 
 directs attention to the marked decline in the relative frequency of the 
 disease, but it is not clear whether the decrease is equivalent to an actual 
 diminution or to an improvement in the more correct diagnosis. It is said, 
 for illustration, that the general results of the caste statistics point to the 
 conclusion that the high proportional figures for Assam are due in a great 
 measure to the confusion of leprosy with other corrosive or skin diseases. 
 Of interest in this connection is a statement that "once a person is attacked 
 
 36 
 
with leprosy, his expectation of life is considerably diminished, the aver- 
 age period after the appearance of the disease being from 10 to 18 years." 
 
 The report for Burma (Rangoon, 1912) shows an increase in the 
 frequency of the disease, the nimiber of lepers in 1911 being 4,842 males 
 and 2,196 females, or, respectively, 40 and 18 per 100,000 of population. 
 The author of the report, Mr. C. Morgan Webb, directs attention to the 
 interesting fact that there is an exceptionally low proportion of leprosy 
 in the five sea-coast districts, and states that "this would appear to effect- 
 ively dispose of the theory of Dr. Hutchinson that leprosy is caused by a 
 bacillus introduced into the stomach by means of badly cured fish, eaten 
 in a state of partial decomposition and not sufficiently cooked." It is 
 explained in this connection that "the comparative absence of leprosy in 
 coast districts would appear to be a stronger argument against the theory, 
 than its presence in regions remote from seas and rivers. However the 
 theory has not yet succeeded in receiving general acceptance. Apart from 
 the comparative immunity of the coast districts from leprosy no rule for 
 its general distribution by locality can be formulated. It cannot be said 
 to be more prevalent in wet districts than in dry districts or vice versa, 
 nor does the contour of the country or the diversity of its surface appear 
 to have any appreciable effect on the prevalence of this infirmity." 
 
 In addition to the foregoing, however, the report directs attention to 
 the high degree of prevalence of leprosy among the Inthas, a tribe of lake 
 dwellers of Burmese race, which seems to support the theory of Dr. Hutch- 
 inson that leprosy is caused by the consumption of badly cooked and 
 badly cured fish. The views of Sir Jonathan Hutchinson have been set 
 forth in a treatise entitled "On Leprosy and Fish Eating," (London, 1906) 
 which contains a number of very suggestive references to Burma and the 
 Burmese type of leprosy (p. 350 et seq.). 
 
 Aside from much other interesting information, the report restates the 
 conclusions of the British and Colonial delegates to the International Con- 
 ference on Leprosy held at Bergen, Norway, in 1909, as follows: 
 
 "(1) Leprosy is spread by direct and indirect contagion from persons suffer- 
 ing from the disease. The possibility that indirect contagion may be efifected by 
 fleas, bugs, lice, the itch, etc., has to be borne in mind. Leprosy is most preva- 
 lent under conditions of personal and domestic uncleanliness and overcrowding, 
 especially w^here there is close and protracted association between the leprous 
 and non-leprous. 
 
 "(2) Leprosy is not due to the eating of any particular food, such as fish. 
 
 "(3) There is no evidence that leprosy is hereditary; the occurrence of 
 several cases in a single family is due to contagion. 
 
 "(4) In leprosy an interval of years may elapse between infection and the 
 first recognised appearance of the disease. It is a disease of long duration, 
 though some of its symptoms may be quiescent for a considerable period and 
 then recur. 
 
 "(5) The danger of infection from leprous persons is greater when there is 
 discharge from mucous membranes or from ulcerated surfaces. 
 
 "(6) Compxdsory notification of every case of leprosy should be enforced. 
 
 "(7) The most important administrative measure is to separate the leprous 
 from the non-leprous by segregation in settlements or asylums. 
 
 37 
 
"(8) In settlements, home life may be permitted under regulation by the 
 responsible authorities. 
 
 "(9) The preceding recommendations, if carried out, will provide the most 
 efficient means of mitigating the leper's suffering and of assisting in his recov- 
 ery, and at the same time will produce a reduction and ultimate extinction of 
 the disease." (pp. 234-5.) 
 
 In the provinces of Bengal, Bihar and Orissa leprosy is unusually 
 prevalent in two well-defined centers, which contaia some 12,600 enumer- 
 ated cases. The average rate is as high as 160 per 100,000 of population, 
 and reaches a maximum intensity in the Bankura district, with a rate of 
 230. Since 1901 there has been a general decline of leprosy throughout 
 the provinces, or for males from 72 to 62 and for females from 23 to 21 
 per 100,0'00 of population. The decrease is ia part ascribed to a more 
 accurate diagnosis of leprosy and particularly to such complaints as leuco- 
 derma and secondary syphilis, which are excluded from the returns. It, 
 however, is held that there is no question of doubt that leprosy is gradually 
 though slowly, becoming less common. 
 
 Recalling the previous statement that a leper's life is a comparatively 
 short one, the observation is of interest tliat "according to one of the most 
 reliable estimates, tlie average duration of life from the date of attack is 
 only nine and one-half years for tuberculated and eighteen and one-half 
 years for anesthetic leprosy." 
 
 Reference is made to the Lepers' act of 1898, applicable to the whole of 
 India, which provides for the establishment of asylums to which lepers may 
 be sent from specified areas and for the arrest of pauper lepers found 
 wandering in such areas, and for their detention in an asylum. It also 
 empowers the local government to prohibit lepers from engaging in cer- 
 tain trades or occupations likely to endanger the public health. 
 
 Referring to the views of Sir Jonathan Hutchinson, as regards causa- 
 tion of leprosy among fish eating races, it is pointed out in the report that: 
 
 "Mr. Hutchinson's theory is not confirmed by the results of the census over 
 the areas where leprosy is most prevalent. In Bankura, in particular, which is 
 the worst leper centre in either Province, the consumption of badly cooked fish 
 is extremely rare. On the other hand, it is common among the Nepalese races, 
 who fulfil the conditions necessary according to Mr. Hutchinson, for (1) the 
 fish they eat is badly cured, (2) it is eaten very largely, (3) it is in a state of 
 partial decomposition and (4) it is imported from distant places. In every 
 bazar frequented by the Nepalese such badly cured fish may be seen. Its 
 condition will be sufficiently described by a quotation from Mr. Inglis an old 
 planter of North Bihar. Large quantities of dried fish are sent to Nepal, and 
 exchanged for rice and other grains, or horns, hides and blankets. The fish- 
 drying is done very simply in the sun. It is generally left till it is half putrid 
 and taints the air for miles. The sweltering, half-rotting mass, packed in filthy 
 bags, and slung on ponies or bullocks, is sent over the frontier to some village 
 bazar in Nepal. The track of a consigmnent of this horrible filth can be recog- 
 nized from very far away. The perfume hovers on the road, and as you are 
 riding up and get the first sniff of the putrid odour, you know at once that the 
 Nepalese market is being recruited by a fresh accession of very stale fish. If 
 the taste is at all equal to the smell, the rankest witches' broth ever brewed in 
 a reeking cauldron would be preferable. The localities where the Nepalese are 
 found in greatest strength have little leprosy, viz., Darjeeling, where the propor- 
 
 38 
 
tion of male lepers per 100,000 is 45, and, Sikkira, where it falls to 16. The 
 figures for Nepalese castes, however, show that the incidence of leprosy is very 
 low; out of 35,000 persons belonging to different Nepalese castes in Sikkim 
 only six are lepers." 
 
 In the Central provinces and Berar the local variation in leprosy in- 
 cidence is very considerable, the average being as high as 46 per 100,000 
 of population. The total number of lepers in the two provinces is 7,307. 
 It is pointed out that women seem to be attacked by the disease at an 
 earlier age than men, and that the higher ratio of male lepers is in part 
 accounted for by the more successful concealment of female cases, as well 
 as by the apparently higher mortality "among leprous women who will 
 not so readily solicit charity as men by displaying the disease in public." 
 
 For Madras the local census report is unfortunately not available, nor 
 for the province of Bombay. For the United provinces of Agra and Oudh 
 (Allahabad, 1912) the report prepared by E. A. H. Blimt, I.C.S., contains 
 a considerable amount of extremely interesting and suggestive data indi- 
 cating also a wide variation in local incidence, from a minimum rate of 
 less than 10 per 100,000 to a maximimi of over 100. The total number of 
 lepers in 1911, including native states, was about 14,500, which compares 
 with not quite 12,000 in 1901. The increase is equivalent to about 24 per 
 cent. The Himalayan division has incomparably the largest number of 
 lepers, although there is a decrease both amongst males and females, and 
 the figures are obscured by the presence of several asylums. In marked 
 contrast to previous observations, in this report the view is advanced that 
 "since the life of a leper seldom exceeds twenty years, it is obvious that a 
 very large part of any increase must be due to fresh cases." Unless the 
 majority of cases are of the anesthetic type, it is doubtful whether the 
 average after-lifetime of a leper would exceed twelve years. It is observed 
 that "leprosy has at all times proved a medical puzzle; despite all the 
 attention it has received, its causation is still unkno^vn and a cure is un- 
 known." This statement might easily mislead those who are not aware of 
 the fact that the causative factor, or bacillus lepra has been thoroughly 
 identified and is easily recognized, although the form of transmission or 
 spread of the disease still remains shrouded in mystery. Reference is made 
 to the Lepers' act of 1898, which contains a provision that "lepers may 
 be forbidden to follow callings connected with the preparation and sale 
 of food, drink, drugs, tobacco and clothing, domestic service, medical 
 practice, midwifery, washing clothes, hair cutting, shaving, or callings 
 which necessitate the handling of food and drink: and also to bathe, 
 wash clothes in, or take water from, certain wells or tanks or use any 
 public carriage save a railway carriage." Finally, it is pointed out in the 
 report that "the great majority of lepers are not and cannot be segregated." 
 Since the total number of lepers in British territory was 14,143 in 1911, 
 aside from 377 lepers in native states, the importance of this conclusion 
 is obvious. 
 
 39 
 
The Census Report of the Northwest Frontier province (Peshawar, 
 1912), prepared by C. Latimer, LC.S., also calls attention to the diminu- 
 tion of the disease from an actual number of 294 cases in 1901 to 282 
 in 1911. Attention is directed to the excessive frequency of the disease in 
 the hill districts and to the incidence of leprosy in the province of Kash- 
 mir, which for 1901 experienced a rate of 72 per 100,000 for males and 
 36 for females. It is observed in this connection that "whether this result is 
 to be regarded as connecting leprosy with syphilis, which is known to be 
 common in the hills, or whether the variation is due to difference in the 
 food eaten, it is impossible to say," for "the causes which predispose to 
 the disease do not seem to have been accurately determined; and no cor- 
 respondeifce could be traced between the physical and climatic character- 
 istics, or between the race and staple diet of their inhabitants." 
 
 For the native state of Travancore, the census report for 1911, pre- 
 pared by IN'. Subramhanya Aiyar (Trivandrum, 1912), the local frequency 
 is given as 49 male lepers per 100,000 of population, and 16 females. 
 Since 1901 "there has been a perceptible decrease in the number of lepers, 
 the decline amounting to 21 per cent." Attention is directed to the sudden 
 increase in leprosy during the age period 10-20, when apparently the risk 
 of infection is greatest. 
 
 In the native state of Coorg, the report for 1911, prepared by J. 
 Chartres Molony, LC.S. (Madras, 1912), contains no extended observa- 
 tions on the subject of leprosy, but the statistical results show a very 
 marked decline in relative frequency, or, for the male population from 25 
 per 100,000 in 1881 to 6 in 1911, while for females the rate has declined 
 from 23 in 1881 to 4 in 1901, no rate being given for the last census year. 
 
 Finally, in the native state of Baroda, according to the administration 
 report, 1917-1918, the number of lepers treated at the asylum was 160 
 against 169 in 1916-17, but such figures are, however, not very trustworthy 
 as an index of a possible diminution or increase in frequency, as is made 
 evident by the statement that 71 patients absconded during the year under 
 review, the question now being under consideration to wall in the asyliun 
 to increase the difficulty of escapes.* 
 
 *0n the proposed establishment of more and model leper farm colonies in India see the British Medical 
 Journal, of December 20, 1919. 
 
 40 
 

 APPENDIX B 
 
 Leprosy Statistics 
 
 
 
 
 
 
 Table I 
 
 
 
 
 
 Analysis of Leper Admissions to the Louisiana Leper Home 
 
 
 
 Rates per 
 
 1,000,000 
 
 Population 
 
 
 
 
 New Cases 
 
 
 
 
 
 Calendar Louisiana 
 
 Admitted each year (z) 
 
 Deaths 
 
 Remaining (x) 
 
 Year Population 
 
 No. 
 
 Rate 
 
 No. 
 
 Rate 
 
 No. 
 
 Rate 
 
 1894 1,223,801 
 
 8 
 
 6.5 
 
 — 
 
 — 
 
 — 
 
 
 
 1895 1,250,105 
 
 18 
 
 14.4 
 
 4 
 
 3.2 
 
 — 
 
 — 
 
 1896 1,276,409 
 
 3 
 
 2.4 
 
 3 
 
 2.4 
 
 22 
 
 17.2 
 
 1897 1,302,713 
 
 6 
 
 4.6 
 
 4 
 
 3.1 
 
 — 
 
 — 
 
 1898 1,329,017 
 
 5 
 
 3.8 
 
 1 
 
 — 
 
 23 
 
 17.3 
 
 1899 1,355,321 
 
 2 
 
 1.5 
 
 3 
 
 2.2 
 
 — 
 
 — 
 
 1900 1,381,625 
 
 7 
 
 5.1 
 
 6 
 
 4.3 
 
 30 
 
 21.7 
 
 1901 1,409,101 
 
 10 
 
 7.1 
 
 5 
 
 3.5 
 
 — 
 
 — 
 
 1902 1,436,577 
 
 10 
 
 7.0 
 
 7 
 
 4.9 
 
 38 
 
 26.5 
 
 1903 1,464,053 
 
 7 
 
 4.8 
 
 9 
 
 6.1 
 
 — 
 
 — 
 
 1904 1,491,529 
 
 13 
 
 8.7 
 
 2 
 
 1.3 
 
 38 
 
 25.5 
 
 1905 1,519,005 
 
 10 
 
 6.6 
 
 2 
 
 1.3 
 
 — 
 
 — 
 
 1906 1,546,481 
 
 11 
 
 7.1 
 
 3 
 
 1.9 
 
 47 
 
 30.4 
 
 1907 1,573,957 
 
 8 
 
 5.1 
 
 1 
 
 0.6 
 
 — 
 
 — 
 
 1908 1,601,434 
 
 8 
 
 5.0 
 
 1 
 
 0.6 
 
 47 
 
 29.3 
 
 1909 1,628,911 
 
 18 
 
 11.1 
 
 7 
 
 4.3 
 
 — 
 
 — 
 
 1910 1,656,388 
 
 17 
 
 10.3 
 
 3 
 
 1.8 
 
 66 
 
 39.8 
 
 1911 1,683,864 
 
 15 
 
 8.9 
 
 7 
 
 4.2 
 
 — 
 
 — 
 
 1912 1,711,340 
 
 12 
 
 7.0 
 
 ■ 4 
 
 2.3 
 
 74 
 
 43.2 
 
 1913 1,738,816 
 
 27 
 
 15.5 
 
 8 
 
 4.6 
 
 — 
 
 — 
 
 1914 1,773,482 
 
 22 
 
 12.4 
 
 5 
 
 2.8 
 
 87 
 
 49.1 
 
 1915 1,801,306 
 
 23 
 
 12.8 
 
 9 
 
 5.0 
 
 — 
 
 — 
 
 1916 1,829,130 
 
 22 
 
 12.0 
 
 16 
 
 8.7 
 
 103 
 
 56.3 
 
 1917 1,856,954 
 
 9 
 
 4.8 
 
 4 
 
 2.2 
 
 — 
 
 — 
 
 1918 1,884,778 
 
 15 
 
 8.0 
 
 4 
 
 2.1 
 
 89 
 
 47.2 
 
 1919 1,912,602 
 
 16 
 
 8.4 
 
 5 
 
 2.6 
 
 91 
 
 47.6 
 
 1920 1,940,426 
 
 — 
 
 — 
 
 — 
 
 — 
 
 87 
 
 44.8 
 
 (z) Actual count of cases. 
 
 
 
 
 
 
 (x) Remaining at time Report is made : 
 
 in April. 
 
 
 
 
 
 Data from Biennial 
 
 Reports of the Board of Control. 
 
 (Incomplete 
 
 records.) 
 
 
 Table II 
 
 Analysis of Admissions to Leper Home, La. 
 
 For the Period December 1, 1894, to December 31, 1915 
 
 Age on 
 
 Males 
 
 Females 
 
 Males and 
 
 Admission 
 
 Cases 
 
 Cases 
 
 Females, Cases 
 
 -10 
 
 4 
 
 1 
 
 5 
 
 10-14 
 
 16 
 
 8 
 
 24 
 
 15-19 
 
 21 
 
 11 
 
 32 
 
 20-29 
 
 34 
 
 15 
 
 49 
 
 30-39 
 
 28 
 
 12 
 
 40 
 
 40-49 
 
 22 
 
 16 
 
 38 
 
 50-59 
 
 25 
 
 14 
 
 39 
 
 60-69 
 
 7 
 
 8 
 
 15 
 
 70 and Over 
 
 4 
 
 4 
 
 8 
 
 Unknown 
 
 5 
 
 2 
 
 7 
 
 166 
 
 91 
 
 257 
 
 All Ages 
 Average Age 
 
 on Admission 33.8 37.3 35.0 
 
 Data from Biennial Reports of the Board of Control for the Leper Home. 
 
 41 
 
Table III 
 
 Lepers at Isolation Hospital, San Francisco, California 
 
 Rates per 1,000,000 of Population 
 
 Year Ending 
 
 
 Admissions 
 
 Deaths 
 
 Remaining 
 
 June 30 
 
 Population 
 
 No. 
 
 Bate 
 
 No. 
 
 Rate 
 
 No. 
 
 Rate 
 
 1900 
 
 342,782 
 
 1 
 
 2.9 
 
 2 
 
 5.8 
 
 19 
 
 55.4 
 
 1901 
 
 350,195 
 
 5 
 
 14.3 
 
 2 
 
 5.7 
 
 21 
 
 60.0 
 
 1902 
 
 357,608 
 
 9 
 
 25.2 
 
 1 
 
 2.8 
 
 27 
 
 75.5 
 
 1903 
 
 365,021 
 
 3 
 
 8.2 
 
 1 
 
 2.7 
 
 26 
 
 71.2 
 
 1904 
 
 372,434 
 
 3 
 
 8.1 
 
 3 
 
 8.1 
 
 19 
 
 51.0 
 
 1905 
 
 379,847 
 
 . — 
 
 — 
 
 4 
 
 10.5 
 
 15 
 
 39.5 
 
 1906 
 
 387,260 
 
 4 
 
 10.3 
 
 3 
 
 7.7 
 
 20 
 
 51.6 
 
 1907 
 
 394,673 
 
 — 
 
 — 
 
 4 
 
 10.1 
 
 15 
 
 38.0 
 
 1908 1 
 
 402,086 
 
 4 
 
 9.9 
 
 — 
 
 — 
 
 17 
 
 42.3 
 
 1909 
 
 409,499 
 
 3 
 
 7.3 
 
 3 
 
 7.3 
 
 16 
 
 39.1 
 
 1910 
 
 416,912 
 
 5 
 
 12.0 
 
 3 
 
 7.2 
 
 17 
 
 40.8 
 
 1911 
 
 424,325 
 
 2 
 
 4.7 
 
 — 
 
 — 
 
 18 
 
 42.4 
 
 1912 
 
 431,738 
 
 5 
 
 11.6 
 
 2 
 
 4.6 
 
 18 
 
 41.7 
 
 1913 
 
 439,151 
 
 5 
 
 11.4 
 
 3 
 
 6.8 
 
 16 
 
 36.4 
 
 1914 
 
 446,564 
 
 4 
 
 9.0 
 
 3 
 
 6.7 
 
 14 
 
 31.4 
 
 1915 
 
 453,977 
 
 1 
 
 2.2 
 
 1 
 
 2.2 
 
 15 
 
 33.0 
 
 1916 
 
 461,390 
 
 1 
 
 2.2 
 
 2 
 
 4.3 
 
 20 
 
 43.3 
 
 1917 
 
 468,803 
 
 13 
 
 27.7 
 
 3 
 
 6.4 
 
 17 
 
 36.3 
 
 1918 
 
 476,216 
 
 7 
 
 14.7 
 
 5 
 
 10.5 
 
 19 
 
 39.9 
 
 1919 
 
 483,629 
 
 1 
 
 2.1 
 
 1 
 
 2.1 
 
 20 
 
 41.4 
 
 Data from the Reports of the Department of Public Health, San Francisco, Calif. 
 
 Table IV 
 Leprosy in Massachusetts, Penikese (Island) Hospital^ 
 
 
 
 
 Ri 
 
 ates 
 
 per 1,000,000 
 
 Population 
 
 
 
 Year Ei 
 
 iding 
 
 
 
 
 Admitted 
 
 
 Died 
 
 Remaining 
 
 Novem) 
 
 DerSO 
 
 Population 
 
 
 
 No. Rate 
 
 No. ' 
 
 Rate 
 
 No. 
 
 Rate 
 
 1905 
 
 
 3,003,680 
 
 
 
 5 1.7 
 
 — 
 
 — 
 
 5 
 
 1.7 
 
 1906 
 
 
 3,076,224 
 
 
 
 — — 
 
 — 
 
 — 
 
 5 
 
 1.6 
 
 1907 
 
 
 3,148,768 
 
 
 
 4 1.3 
 
 1 
 
 0.3 
 
 8 
 
 2.5 
 
 1908 
 
 
 3,221,312 
 
 
 
 1 0.3 
 
 — 
 
 — 
 
 8 
 
 2.5 
 
 1909 
 
 
 3,293,856 
 
 
 
 3 0.9 
 
 — 
 
 — 
 
 10 
 
 3.0 
 
 1910 
 
 
 3,366,416 
 
 
 
 1 0.3 
 
 — 
 
 — 
 
 11 
 
 33 
 
 1911 
 
 
 3,431,792 
 
 
 
 2 0.6 
 
 — 
 
 — 
 
 13 
 
 3.8 
 
 1912 
 
 
 3,497,168 
 
 
 
 4 1.1 
 
 1 
 
 0.3 
 
 15 
 
 4.3 
 
 1913 
 
 
 3,562,544 
 
 
 
 2 0.6 
 
 1 
 
 0.3 
 
 15 
 
 4.2 
 
 1914 
 
 
 3,627,920 
 
 
 
 — — 
 
 1 
 
 0.3 
 
 13 
 
 3.6 
 
 1915 
 
 
 3,693.310 
 
 
 
 1 0.3 
 
 3 
 
 0.8 
 
 11 
 
 3.0 
 
 1916 
 
 
 3,758,688 
 
 
 
 2 0.5 
 
 4 
 
 1.1 
 
 9 
 
 2.4 
 
 1917 
 
 
 3,824,067 
 
 
 
 3 0.8 
 
 1 
 
 0.3 
 
 11 
 
 2.9 
 
 1918 
 
 
 3,889,446 
 
 
 
 2 0.5 
 
 — 
 
 — 
 
 12 
 
 3.1 
 
 1919 
 
 
 3,954,825 
 
 
 
 2 0.5 
 
 — 
 
 — 
 
 13 
 
 3.3 
 
 D 
 
 ata from the Reports 
 
 of the State Board of Charities 
 
 ; of Massachusetts. 
 
 
 *0f the 29 lepers apprehended in the state of Massachusetts during the period 1882-1915, the distribu- 
 tion by types of disease was as follows: Tubercular 22, or 75.9 per cent.; anesthetic 4, or 13.8 per cent.; 
 mixed 2, or 6.9 per cent. ; unknown 1, or 3.4 per cent. Of the total number of admissions 23 were males 
 and 6 were females ; of the latter, 4 were of the tubercular type. 
 
 Of the 23 male cases apprehended, 9, or 39.1 per cent., died during the period under review; or, 
 if the tubercular cases are separately considered, out of 18 cases, 7 died, or 38.9 per cent. Of the 6 
 female cases, 2 died, or 33.3 per cent. Of the 29 cases, 10, or 34.1 per cent., were of the age period 
 20-29, which may be considered the age period most liable to infection. Of the 29 cases only 4 were natives 
 of the United States, and of these, two were born in the Hawaiian Islands, 1 in a foreign country and only 
 1 in the state of Louisiana. The remainder had come to this country from the Azores, Cape Verde, British 
 West Indies, China, Greece, Italy, Japan, Russia, Sweden and Syria. 
 
 42 
 
Table V 
 Leprosy in the United States Registration Area 
 
 Year 
 
 1900 
 1901 
 1902 
 1903 
 1904 
 1905 
 1906 
 1907 
 1908 
 1909 
 1910 
 1911 
 1912 
 1913 
 1914 
 1915 
 1916 
 1917 
 1918 
 
 Population 
 
 30,794,273 
 31,370,952 
 32,029,815 
 32,701,083 
 33,349,139 
 34,094,605 
 41,983,419 
 43,016,990 
 46,789,913 
 50,870,518 
 53,843,896 
 59,275,977 
 60,427,133 
 63,299,164 
 65,989,295 
 67,336,992 
 71,621,632 
 75,527,486 
 81,868,104 
 
 Deaths 
 
 4 
 
 6 
 
 5 
 
 4 
 
 4 
 
 8 
 
 3 
 
 7 
 11 
 
 9 
 10 
 
 7 
 11 
 
 6 
 12 
 13 
 11 
 17 
 24 
 
 Rate per 
 Million 
 
 0.13 
 0.19 
 0.16 
 0.12 
 0.12 
 0.23 
 0.07 
 0.16 
 0.24 
 0.18 
 0.19 
 0.12 
 0.18 
 0.09 
 0.18 
 0.19 
 0.15 
 0.23 
 0.29 
 
 Table VI 
 
 Deaths from Leprosy in the United States Registration Area 
 
 BY States, 1907-1918 
 
 , ^YEARS . 
 
 States '07 '08 '09 '10 '11 '12 '13 '14 '\5 '16 '17 '18 Total 
 
 CaUfornia 353243-33— 6^ 37 
 
 Connecticut — — — — — — 1 " ~ ~ f- 
 
 Florida _2-l---211^19 
 
 Indiana — • — — — — 1 -,,^ 
 
 Louisiana* 1 2— 2 — - — — 1 — — 11 17 
 
 Massachusetts 1 — — — — 1 1 1 3 4 1 — 12 
 
 Michigan — — — — — 2 2— 4 
 
 Minnesota __— 1 2— 1— 1 1 — — 7 
 
 New Jersey _ — — — — ~~ ~ ~ ~ ~Z ] ~^ ^n 
 
 New York 1-211112-442 19 
 
 Ohio - ^ — ~~~~~~'~~''Z1. \ 
 
 Pennsylvania — 1 — — — — — 1 ^ ^ 
 
 Rhode Island __ — — — — — — 1 — — — 1 
 
 South Carolina — — — 2 — — — 2— 1 1 1 7 
 
 Texas i _ _ _ _ _ 2 1 1 - 2 - 7 
 
 Washington — — — — — — — — ^ j 
 
 Wisconsin — — — 1 — — — 
 Registration cities 
 
 in other States — — 4 — — 3 — — ' 
 
 139 
 
 ♦For years previous to 1918, data for New Orleans only. 
 
 43 
 
Year 
 
 1902 
 1903 
 1904 
 1905 
 1906 
 1907 
 1908 
 1909 
 1910 
 1911 
 1912 
 1913 
 1914 
 
 
 Table VII 
 
 
 
 lY FROM 
 
 Leprosy in 
 
 Cuba, 1903-1914 
 
 
 
 
 Deaths 
 
 Rate per 
 
 Population 
 
 
 from Leprosy 
 
 Million 
 
 1,751,366 
 
 
 17 
 
 9.7 
 
 1,810,889 
 
 
 31 
 
 17.1 
 
 1,870,412 
 
 
 17 
 
 9.1 
 
 1,929,935 
 
 
 29 
 
 15.0 
 
 1,989,458 
 
 
 39 
 
 19.6 
 
 2,048,980 
 
 
 47 
 
 22.9 
 
 2,082,691 
 
 
 30 
 
 14.4 
 
 2,116,402 
 
 
 25 
 
 11.8 
 
 2,150,112 
 
 
 35 
 
 16.3 
 
 2,183,823 
 
 
 53 
 
 24.3 
 
 2,217,534 
 
 
 37 
 
 16.7 
 
 2,251,245 
 
 
 43 
 
 19.1 
 
 2,284,956 
 
 
 45 
 
 19.7 
 
 Source: Sanidad y Beneficencia, Boletin Oficial de la Secretaria, Habana. 
 
 Table VIII 
 
 Leprosy in Cuba 
 
 Year 
 
 1909 
 1910 
 1911 
 1912 
 1913 
 1914 
 
 Population 
 
 2,116,402 
 2,150,112 
 2,183,823 
 2,217,534 
 2,251,245 
 2,284,956 
 
 Reported Cases 
 
 Remaining at 
 
 End of Each Year 
 
 321 
 343 
 350 
 338 
 341 
 351 
 
 Rate per 
 Million of 
 Population 
 
 151.7 
 159.5 
 160.3 
 152.4 
 151.5 
 153.6 
 
 Data from Sanidad y Beneficencia, Boletin Oficial de la Secretaria, Habana. 
 
 Table IX 
 
 Statistics of the Leper Colony, Goat Island, San Juan, Porto Rico, 
 
 1905-1919 
 
 Year 
 
 1905 
 1906 
 1907 
 1908 
 1909 
 1910 
 1911 
 1912 
 1913 
 1914 
 1915 
 1916 
 1917 
 1918 
 1919 
 
 Population 
 
 of 
 Porto Rico 
 
 1,042,342 
 1,058,134 
 1,073,926 
 1,089,718 
 1,105,510 
 1,121,302 
 1,137,094 
 1,152,886 
 1,168,678 
 1,184,470 
 1,200,262 
 1,216,054 
 1,231,846 
 1,247,638 
 1,263,430 
 
 
 Rate Per 
 
 Inmates on 
 
 Million of 
 
 June 30 
 
 Population 
 
 18 
 
 17.3 
 
 25 
 
 23.6 
 
 25 
 
 23.3 
 
 19 
 
 17.4 
 
 24 
 
 21.7 
 
 25 
 
 22.3 
 
 25 
 
 22.0 
 
 28 
 
 24.3 
 
 28 
 
 24.0 
 
 36 
 
 30.4 
 
 39 
 
 32.5 
 
 39 
 
 31.3 
 
 39 
 
 30.9 
 
 Source : Annual Reports of the Governor of Porto Rico to the Secretary of War. 
 
 44 
 
Table X 
 
 Leprosy in Panama Canal Zone, Palo Seco Leper Asylum 
 
 Rates per 1,000,000 Population of Panama Canal Zone and Cities of 
 
 Colon and Panama 
 
 
 
 Ada: 
 
 lissions 
 
 Deaths 
 
 Remainine 
 
 Year 
 
 Population 
 
 No. 
 
 Rate 
 
 No. Rate 
 
 No. 
 
 Rate 
 
 1907 
 
 102,133 
 
 — 
 
 
 1 9.8 
 
 14 
 
 137.1 
 
 1908 
 
 120,097 
 
 14 
 
 116.6 
 
 — — 
 
 22 
 
 183.2 
 
 1909 
 
 135,180 
 
 24 
 
 177.5 
 
 1 7.4 
 
 34 
 
 251.5 
 
 1910 
 
 151,591 
 
 15 
 
 99.0 
 
 3 19.8 
 
 36 
 
 237.5 
 
 1911 
 
 156,936 
 
 24 
 
 152.9 
 
 2 12.7 
 
 49 
 
 312.2 
 
 1912 
 
 146,510 
 
 12 
 
 81.9 
 
 7 47.8 
 
 48 
 
 327.6 
 
 1913 
 
 129,104 
 
 15 
 
 116.2 
 
 9 69.7 
 
 45 
 
 348.6 
 
 1914 
 
 123,592 
 
 14 
 
 113.3 
 
 6 48.5 
 
 50 
 
 404.6 
 
 1915 
 
 121,650 
 
 11 
 
 90.4 
 
 2 16.4 
 
 58 
 
 476.8 
 
 1916 
 
 116,918 
 
 21 
 
 179.6 
 
 9 77.0 
 
 66 
 
 564.5 
 
 1917 
 
 (x) 114,003 
 
 11 
 
 96.5 
 
 7 61.4 
 
 67 
 
 587.7 
 
 1918 
 
 (x) 109,737 
 
 21 
 
 191.4 
 
 8 72.9 
 
 76 
 
 692.6 
 
 (x) Excluding the military for last six months of 1917 and the whole of 1918. 
 
 Data from Reports of the Health Department of the Panama Canal. 
 
 Table XI 
 
 Leprosy in Panama Canal Zone, Palo Seco Leper Asylum 
 Number of Deaths of Lepers from 1907-1915 
 
 Type of Disease 
 on Admission 
 
 Tubercular 
 Anesthetic 
 Mixed 
 Total 
 
 Males 
 Number 
 
 18 
 3 
 3 
 
 24 
 
 Females 
 Number 
 
 6 
 2 
 1 
 9 
 
 Males and 
 Females 
 Number 
 
 34 
 
 5 
 
 4 
 33 
 
 Nativity on Admission 
 
 
 Number Males 
 
 Nativity 
 
 White 
 
 Black 
 
 United States 
 
 2 
 
 — 
 
 Spain 
 
 1 
 
 — 
 
 Panama 
 
 — 
 
 6 
 
 Colombia 
 
 — 
 
 2 
 
 Costa Rica 
 
 — 
 
 1 
 
 Jamaica 
 
 — 
 
 5 
 
 Barbados 
 
 — 
 
 4 
 
 Antigua 
 
 — 
 
 1 
 
 China 
 
 — 
 
 1 
 
 Peru 
 
 — 
 
 1 
 
 Number Females 
 White Black 
 
 Total 3 21 — 9 
 
 Source : From data received from Palo Seco Leper Asylum. 
 
 Number 
 
 Males and Females 
 
 White Black 
 
 13 
 3 
 1 
 6 
 4 
 1 
 1 
 1 
 
 30 
 
 Note: — The average duration of the disease has been 7.5 years; or, roughly, 6.8 years for tubercular 
 cases, 8.8 years for anesthetic cases, and 9.8 years for mixed cases. For ages under 15 the average dura- 
 tion was 6.3 years, for ages 15 to 44 it was 6.8 years, and for ages 45 and over, 9.7 years. 
 
 45 
 
Table XII 
 Mortality from Leprosy in the City of Rio de Janeiro, 1890-1918 
 
 Year 
 
 1890 
 1891 
 1892 
 1893 
 1894 
 1895 
 1896 
 1897 
 1898 
 1899 
 1900 
 1901 
 1902 
 1903 
 1904 
 1905 
 1906 
 1907 
 1908 
 1909 
 1910 
 1911 
 1912 
 1913 
 1914 
 1915 
 1916 
 1917 
 1918 
 
 Population 
 
 429,848 
 440,118 
 450,636 
 461,411 
 472,454 
 483,773 
 495,380 
 507,286 
 519,503 
 532,042 
 544,917 
 558,140 
 571,728 
 585,695 
 600,067 
 614,831 
 625,756 
 636,018 
 637,089 
 649,362 
 669,781 
 708,669 
 749,376 
 754,839 
 738,950 
 737,888 
 719,316 
 696,284 
 700,443 
 
 Deaths 
 
 9 
 13 
 14 
 20 
 18 
 18 
 19 
 18 
 13 
 22 
 10 
 16 
 19 
 20 
 23 
 25 
 22 
 34 
 20 
 14 
 11 
 29 
 25 
 16 
 27 
 21 
 19 
 21 
 23 
 
 Rate per 
 Million 
 
 20.9 
 29.5 
 31.1 
 43.3 
 38.1 
 37.2 
 38.4 
 35.5 
 25.0 
 41.4 
 18.4 
 28.7 
 33.2 
 34.1 
 38.3 
 40.7 
 35.2 
 53.5 
 31.4 
 21.6 
 16.4 
 40.9 
 33.4 
 21.2 
 36.5 
 28.5 
 26.4 
 30.2 
 32.8 
 
 Source: Annuario de Estatistica Demographo-Sanitaria de Rio de Janeiro, and 
 Boletim Mensal de Estatistica Demographo-Sanitaria. 
 
 Table XIII 
 Mortality from Leprosy, City of Sao Paulo, Brazil, 1901-1917 
 
 Year 
 
 1901 
 1902 
 1903 
 1904 
 1905 
 1906 
 1907 
 1908 
 1909 
 1910 
 1911 
 1912 
 1913 
 1914 
 1915 
 1916 
 1917 
 
 Population 
 
 286,000 
 293,200 
 300,400 
 307,600 
 314,800 
 322,000 
 329,200 
 336,400 
 343,600 
 350,800 
 358,000 
 400,000 
 480,000 
 485,000 
 500,000 
 484,901 
 452,028 
 
 No. 
 Deaths 
 
 5 
 
 10 
 
 4 
 
 6 
 
 7 
 17 
 11 
 11 
 
 6 
 23 
 21 
 24 
 19 
 21 
 23 
 32 
 26 
 
 Rate per 
 Million 
 
 17.5 
 34.1 
 13.3 
 19.5 
 22.2 
 52.8 
 33.4 
 32.7 
 17.5 
 65.6 
 58.7 
 60.0 
 39.6 
 43.3 
 46.0 
 66.0 
 57.5 
 
 Data 
 
 from Annuario Demographico, Seccao de Estatistica Demographo-Sanitaria 
 de Sao Paulo. 
 
 Annuario de Estatistica Demographo-Sanitaria de Rio de Janeiro. 
 Boletim Hebdomadario de Estatistica Demographo-Sanitaria de Sao 
 Paulo. 
 
 46 
 
Table XIV 
 
 Deaths from Leprosy in the Federal District of 
 
 Rio de Janeiro, Brazil 
 
 By Sex and Age 
 
 1909-1918 
 
 ]\L\LES 
 
 Ages at 
 
 
 
 Rate per 
 
 Death 
 
 Population 
 
 Deaths 
 
 MiUion 
 
 Under 19 
 
 2,115,954 
 
 6 
 
 2.8 
 
 20-29 
 
 1,247,036 
 
 23 
 
 18.4 
 
 30-39 
 
 885,174 
 
 27 
 
 30.5 
 
 40-49 
 
 591,560 
 
 38 
 
 64.2 
 
 50-59 
 
 293,614 
 
 30 
 
 102.2 
 
 60-69 
 
 120,805 
 
 19 
 
 157.3 
 
 70 and Over 
 
 47,131 
 
 5 
 
 106.1 
 
 FEMALES 
 
 
 
 
 Rate per 
 
 Population 
 
 Deaths 
 
 Million 
 
 1,822,555 
 
 5 
 
 2.7 
 
 790,822 
 
 9 
 
 11.4 
 
 569,392 
 
 15 
 
 26.3 
 
 389,735 
 
 13 
 
 33.4 
 
 226,700 
 
 14 
 
 61.8 
 
 118,012 
 
 10 
 
 84.7 
 
 64,077 
 
 9 
 
 140.5 
 
 All Ages 5,301,274 148 27.9 3,981,293 75 
 
 Data from Annuario de Estatistica Demographo-Sanitaria de Rio de Janeiro. 
 
 Table XV 
 
 Mortality from Leprosy in the Federal District of 
 
 Rio DE Janeiro, Brazil 
 
 By Sex and Nativity 
 
 1909-1918 
 
 18.8 
 
 MALES 
 
 females 
 
 
 
 
 Rate per 
 
 Nativity 
 
 Population 
 
 Deaths 
 
 Million 
 
 Brazilian 
 
 3,575,179 
 
 97 
 
 27.1 
 
 Portugese 
 
 1,164,160 
 
 33 
 
 28.4 
 
 Italian 
 
 196,147 
 
 7 
 
 35.7 
 
 Spanish 
 
 161,159 
 
 5 
 
 31.0 
 
 Other European 66,266 
 
 4 
 
 60.4 
 
 Turko-Arabic 
 
 21,735 
 
 2 
 
 92.0 
 
 AU Other 
 
 116,628 
 
 — 
 
 
 Population 
 
 3,298,899 
 361,900 
 96,347 
 75,246 
 54,146 
 10,749 
 84,006 
 
 Deaths 
 
 64 
 6 
 1 
 1 
 
 1 . 
 1 
 1 
 
 Rate per 
 MiUion 
 
 19.4 
 16.6 
 10.4 
 13.3 
 18.5 
 93.0 
 11.9 
 
 All Nativities 5,301,274 148 27.9 3,981,293 75 18.8 
 
 Data from Annuario de Estatistica Demographo-Sanitaria de Rio de Janerio. 
 
 Table XVI 
 Mortality from Leprosy, City of Recife (Pernajmbuco), Brazil 
 
 1907-1920 
 
 Year 
 
 1907 
 1908 
 1909 
 1910 
 1911 
 1912 
 1913 
 1914 
 1915 
 1916 
 1917 
 
 Population 
 
 159,480 
 166,110 
 
 172,740 
 179,370 
 186,000 
 210,000 
 230,000 
 232,500 
 235,000 
 237,500 
 240,000 
 
 No. of 
 Deaths 
 
 18 
 19 
 12 
 12 
 
 3. 
 10 
 10 
 
 6 
 
 8 
 
 8 
 
 9 
 
 Rate per 
 Million 
 
 112.9 
 114.4 
 69.5 
 66.9 
 16.1 
 47.6 
 43.5 
 25.8 
 34.0 
 33.7 
 37.5 
 
 Data from Annuario de Estatistica Demographo-Sanitaria de Rio de Janeiro. 
 Boletim Mensal de Estatistica Demographo-Sanitaria do Municipio do Recife. 
 
 47 
 

 
 Table XVII 
 
 
 
 Deaths 
 
 FROM Leprosy 
 
 AND Number of Inmates 
 
 IN Leper Asylums, 
 
 
 
 Venezueia, 
 
 1905-1918 
 
 Inmates in 
 
 
 
 
 Deaths from 
 
 Rate per 
 
 Leper Asylums 
 
 Rate per 
 
 Year 
 
 Population 
 
 Leprosy 
 
 Million 
 
 December 31 
 
 Million 
 
 1905 
 
 2,609,108 
 
 81 
 
 31.0 
 
 
 
 1906 
 
 2,627,069 
 
 74 
 
 28.2 
 
 
 
 1907 
 
 2,649,995 
 
 51 
 
 19.2 
 
 666 
 
 251.3 
 
 1908 
 
 2,664,233 
 
 37 
 
 13.9 
 
 632 
 
 237.2 
 
 1909 
 
 2,685,432 
 
 48 
 
 17.9 
 
 621 
 
 231.2 
 
 1910 
 
 2,713,523 
 
 22 
 
 8.1 
 
 612 
 
 225.5 
 
 1911 
 
 2,743,833 
 
 24 
 
 8.7 
 
 611 
 
 222.7 
 
 1912 
 
 2,755,630 
 
 62 
 
 22.5 
 
 582 
 
 211.2 
 
 1913 
 
 ^ 2,780,281 
 
 57 
 
 20.5 
 
 523 
 
 188.1 
 
 1914 
 
 2,805,269 
 
 25 
 
 8.9 
 
 499 
 
 177.9 
 
 1915 
 
 2,818,173 
 
 45 
 
 16.0 
 
 676 
 
 239.9 
 
 1916 
 
 2,827,762 
 
 71 
 
 25.1 
 
 650 
 
 229.9 
 
 1917 
 
 2,848,121 
 
 33 
 
 11.6 
 
 626 
 
 219.8 
 
 1918 
 
 2,868,480 
 
 28 
 
 9.8 
 
 753 
 
 262.5 
 
 Data from Anuario Estadistico de Venezuela and Memoria del Ministerio de 
 Fomento. 
 
 Table XVIII 
 
 Mortality of Lepers in the Lazaretto of Barbados 
 
 For the Period, 1890-1917 
 
 Males and Females 
 
 Causes of Death 
 
 Dysentery 
 
 Leprosy 
 
 Tuberculous Lungs 
 
 Other General 
 
 Apoplexy 
 
 Paralysis 
 
 Other Nervous 
 
 Organic Heart Disease 
 
 Other Circulatory 
 
 Respiratory 
 
 Diarrhea and Enteritis 
 
 Other Digestive 
 
 Brights Disease 
 
 Other Urinary 
 
 Gangrene 
 
 Ill-defined 
 
 Tubercular 
 Males Females 
 No. 
 
 No. 
 
 2 
 
 125 
 
 17 
 
 4 
 
 1 
 
 2 
 4 
 
 4 
 7 
 1 
 
 1 
 
 3 
 2 
 
 1 
 79 
 12 
 
 3 
 
 1 
 1 
 6 
 1 
 1 
 2 
 3 
 
 Anesthetic 
 
 Males Females 
 
 No. No. 
 
 2 — 
 
 21 
 7 
 5 
 6 
 3 
 1 
 
 All Causes 173 118 68 
 
 Data from The Barbados Blue Book. 
 
 29 
 
 10 
 
 2 
 
 3 
 
 2 
 1 
 
 2 
 2 
 
 54 
 
 Mixed 
 Males Females 
 No. No. 
 
 — 2 
 
 All Types 
 
 Males Females 
 
 No. No. 
 
 4 
 149 
 
 24 
 
 10 
 6 
 4 
 3 
 
 12 
 1 
 6 
 
 10 
 3 
 2 
 2 
 4 
 6 
 
 1 
 
 112 
 22 
 5 
 3 
 3 
 2 
 10 
 3 
 1 
 3 
 3 
 1 
 
 4 
 
 7 
 
 246 180 
 
 48 
 

 
 
 Table XIX 
 
 
 
 
 
 
 Leprosy in India, 
 
 1911 
 
 
 
 
 
 Number of 
 
 Lepers by Aj 
 
 ge and Sex 
 
 
 
 
 
 ALL INDIA 
 
 
 
 NATIVE STATED 
 
 5 
 
 Ages 
 
 Males 
 
 Females 
 
 Total 
 
 Males 
 
 Females 
 
 Total 
 
 Under 5 
 
 245 
 
 188 
 
 433 
 
 59 
 
 51 
 
 110 
 
 5-9 
 
 568 
 
 419 
 
 987 
 
 99 
 
 99 
 
 198 
 
 10-14 
 
 1,692 
 
 1,144 
 
 2,836 
 
 306 
 
 223 
 
 529 
 
 15-19 
 
 3,185 
 
 1,814 
 
 4,999 
 
 490 
 
 311 
 
 801 
 
 20-24 
 
 4,752 
 
 2,344 
 
 7,096 
 
 738 
 
 425 
 
 1,163 
 
 25-29 
 
 7,174 
 
 2,653 
 
 9,827 
 
 1,035 
 
 449 
 
 1,484 
 
 30-34 
 
 9,517 
 
 3,327 
 
 12,844 
 
 1,342 
 
 511 
 
 1,953 
 
 35-39 
 
 9,761 
 
 2,754 
 
 12,515 
 
 1,282 
 
 422 
 
 1,704 
 
 40-44 
 
 12,542 
 
 3,558 
 
 16,100 
 
 1,929 
 
 702 
 
 2,631 
 
 45-49 
 
 8,503 
 
 2,252 
 
 10,755 
 
 1,082 
 
 316 
 
 1,398 
 
 50-54 
 
 9,617 
 
 3,025 
 
 12,642 
 
 1,515 
 
 545 
 
 2,060 
 
 55-59 
 
 3,974 
 
 1,260 
 
 5,234 
 
 537 
 
 152 
 
 689 
 
 60-64 
 
 5,553 
 
 1,951 
 
 7,504 
 
 823 
 
 324 
 
 1,147 
 
 65-69 
 
 1,437 
 
 472 
 
 1,909 
 
 192 
 
 61 
 
 253 
 
 70 and over 
 
 2,438 
 
 892 
 
 3,330 
 
 356 
 
 125 
 
 481 
 
 Unknown 
 
 66 
 
 17 
 
 83 
 109,094 
 
 49 
 
 11 
 4,827 
 
 60 
 
 Total 
 
 81,024 
 
 28,070 
 
 11,834 
 
 16,661 
 
 Rate per 100,000 
 
 
 
 
 
 
 of population 50.2 
 
 18.2 
 
 34.6 
 
 32.5 
 
 14.0 
 
 23.5 
 
 Data from Census 
 
 of India, 1911, Volume I. 
 
 
 
 
 
 
 
 Table XX 
 
 
 
 
 Statistics of the Leper Settlement at Molokai, Hawaii 
 
 Admissions, Inmates and Deaths of Lepers, 1866-1919 
 
 Rate per 100,000 Population of Hawaii 
 
 
 Admissions to 
 
 Calendar 
 
 Molokai 
 
 Year 
 
 Number Rate 
 
 1866 (a) 
 
 141 223.9 
 
 1867 
 
 91 146.9 
 
 1868 
 
 131 215.0 
 
 1869 
 
 190 317.0 
 
 1870 
 
 57 96.7 
 
 1871 
 
 178 307.4 
 
 1872 
 
 91 159.9 
 
 1873 
 
 415 727.1 
 
 1874 
 
 78 136.2 
 
 1875 
 
 178 309.9 
 
 1876 
 
 75 130.2 
 
 1877 
 
 122 211.1 
 
 1878 
 
 209 360.4 
 
 1879 
 
 92 149.0 
 
 1880 
 
 51 77.8 
 
 1881 
 
 195 281.5 
 
 1882 
 
 70 95.8 
 
 1883 
 
 300 390.6 
 
 1884 
 
 108 134.0 
 
 1885 
 
 103 125.4 
 
 1886 
 
 43 51.4 
 
 1887 
 
 220 258.0 
 
 (a) Settlement established Janua 
 
 Number of Lepers 
 
 in 
 
 Molokai 
 
 December 31 
 
 Number 
 
 Rate 
 
 115 
 
 182.7 
 
 170 
 
 274.4 
 
 267 
 
 438.1 
 
 392 
 
 654.1 
 
 392 
 
 665.3 
 
 518 
 
 894.5 
 
 546 
 
 959.6 
 
 810 
 
 1,419.1 
 
 731 
 
 1,276.7 
 
 754 
 
 1,312.7 
 
 704 
 
 1,221.8 
 
 694 
 
 1,200.6 
 
 792 
 
 1,365.9 
 
 688 
 
 1,114.2 
 
 589 
 
 899.0 
 
 654 
 
 944.0 
 
 613 
 
 839.2 
 
 763 
 
 993.3 
 
 702 
 
 871.2 
 
 663 
 
 807.1 
 
 600 
 
 716.7 
 
 708 
 
 830.2 
 
 Deaths 
 
 from 
 
 all Causes 
 
 Number 
 
 Rate 
 
 36 
 
 57.2 
 
 24 
 
 38.7 
 
 27 
 
 44.3 
 
 59 
 
 98.4 
 
 57 
 
 96.7 
 
 52 
 
 89.8 
 
 63 
 
 110.7 
 
 142 
 
 248.8 
 
 141 
 
 246.2 
 
 149 
 
 259.4 
 
 119 
 
 206.5 
 
 129 
 
 223.2 
 
 111 
 
 191.4 
 
 194 
 
 314.2 
 
 151 
 
 230.5 
 
 129 
 
 186.2 
 
 111 
 
 152.0 
 
 150 
 
 195.3 
 
 167 
 
 207.3 
 
 142 
 
 172.9 
 
 101 
 
 120.6 
 
 111 
 
 130.2 
 
Table XX (Continued) 
 
 
 
 
 Numl 
 
 ber of Lepers 
 
 
 
 
 Admissions to 
 
 in Molokai 
 
 Deaths from 
 
 Calendar 
 
 Molokai 
 
 December 31 
 
 all Causes 
 
 Year 
 
 N'mnber 
 
 Rate 
 
 Nmnber 
 
 Rate 
 
 Number 
 
 Rate 
 
 1888 
 
 571 
 
 657.4 
 
 1,033 
 
 1,189.4 
 
 236 
 
 271.7 
 
 1889 
 
 307 
 
 347.1 
 
 1,187 
 
 1,342.4 
 
 149 
 
 168.5 
 
 1890 
 
 185 
 
 205.6 
 
 1,213 
 
 1,347.9 
 
 158 
 
 175.6 
 
 1891 
 
 141 
 
 151.4 
 
 1,142 
 
 1,225.8 
 
 210 
 
 225.4 
 
 1892 
 
 105 
 
 109.0 
 
 1,095 
 
 1,136.7 
 
 152 
 
 157.8 
 
 1893 
 
 209 
 
 210.0 
 
 1,153 
 
 1,158.7 
 
 151 
 
 151.8 
 
 1894 
 
 129 
 
 125.6 
 
 1,123 
 
 1,093.7 
 
 159 
 
 154.9 
 
 1895 
 
 105 
 
 99.2 
 
 1,087 
 
 1,027.0 
 
 141 
 
 133.2 
 
 1896 
 
 142 
 
 130.3 
 
 1,115 
 
 1,022.7 
 
 114 
 
 104.6 
 
 1897 
 
 , 124 
 
 103.1 
 
 1,099 
 
 913.8 
 
 140 
 
 116.4 
 
 1898 
 
 75 
 
 57.0 
 
 1,059 
 
 805.3 
 
 114 
 
 86.7 
 
 1899 
 
 61 
 
 42.7 
 
 1,014 
 
 710.3 
 
 104 
 
 72.9 
 
 1900 
 
 109 
 
 70.8 
 
 983 
 
 638.3 
 
 134 
 
 87.0 
 
 1901 
 
 94 
 
 59.6 
 
 900 
 
 570.4 
 
 172 
 
 109.0 
 
 1902 
 
 80 
 
 49.5 
 
 874 
 
 540.9 
 
 106 
 
 65.6 
 
 1903 
 
 114 
 
 68.9 
 
 872 
 
 527.3 
 
 101 
 
 61.1 
 
 1904 
 
 92 
 
 54.4 
 
 856 
 
 506.0 
 
 107 
 
 63.3 
 
 1905 
 
 95 
 
 54.9 
 
 854 
 
 493.8 
 
 95 
 
 54.9 
 
 1906 
 
 64 
 
 36.2 
 
 834 
 
 471.9 
 
 84 
 
 47.5 
 
 1907 
 
 78 
 
 43.2 
 
 809 
 
 448.1 
 
 88 
 
 48.7 
 
 1908 
 
 32 
 
 17.4 
 
 771 
 
 418.3 
 
 59 
 
 32.0 
 
 1909 (b) 
 
 11 
 
 11.4 
 
 723 
 
 376.0 
 
 34 
 
 35.4 
 
 1910 (c) 
 
 47 
 
 24.6 
 
 614 
 
 321.3 
 
 90 
 
 47.1 
 
 1911 
 
 40 
 
 19.9 
 
 592 
 
 295.2 
 
 61 
 
 30.4 
 
 1912 
 
 91 
 
 43.5 
 
 622 
 
 297.4 
 
 64 
 
 30.6 
 
 1913 
 
 113 
 
 51.9 
 
 683 
 
 313.7 
 
 49 
 
 22.5 
 
 1914 
 
 67 
 
 29.5 
 
 666 
 
 292.9 
 
 75 
 
 33.0 
 
 1915 
 
 49 
 
 21.2 
 
 638 
 
 275.9 
 
 62 
 
 26.8 
 
 1916 
 
 57 
 
 24.0 . 
 
 629 
 
 264.7 
 
 66 
 
 27.8 
 
 1917 
 
 34 
 
 13.6 
 
 587 
 
 234.2 
 
 62 
 
 24.7 
 
 1918 
 
 89 
 
 34.7 
 
 608 
 
 237.3 
 
 67 
 
 26.2 
 
 1919 
 
 61 
 
 23.1 
 
 611 
 
 231.7 
 
 57 
 
 21.6 
 
 (b) Six 
 
 months ending June 30. 
 
 
 
 
 
 (c) Years ending June 
 
 30, after 1910. 
 
 
 
 
 
 Source: For 1866-1908, Report of the Board of Health of Hawaii, 1909, p. 186; 
 for subsequent years, see Annual Reports of the Territorial Board of Health. 
 
 
 Table XXI 
 
 
 
 Leprosy 
 
 IN Hawaii 
 
 
 
 Type oi 
 
 ■ Leprosy 
 
 
 
 Molokai, 
 
 1901-1913 
 
 
 Tx-ix- 
 
 Tubercular 
 Anesthetic 
 Mixed 
 Not Given 
 
 
 Number 
 of Cases 
 
 384 
 
 327 
 275 
 
 74 
 
 Per Cent. 
 
 36.2 
 
 30.9 
 
 25.9 
 
 7.0 
 
 Total 
 
 1.060 
 
 100.0 
 
 50 
 
Table XXII 
 
 Leprosy in Hawaii 
 
 Lepers by Race and Sex 
 
 MoLOKAi, June 30, 1918 
 
 Rate per 100,000 Population 
 
 Males 
 
 Race 
 
 Number 
 
 Rate 
 
 Hawaiian 
 
 210 
 
 1,780.7 
 
 Part Hawaiian 
 
 64 
 
 795.3 
 
 Korean 
 
 12 
 
 276.8 
 
 Portuguese 
 
 33 
 
 262.3 
 
 Spanish 
 
 2 
 
 162.6 
 
 Chinese 
 
 25 
 
 142.0 
 
 Filipino 
 
 12 
 
 65.4 
 
 Porto Rican 
 
 2 
 
 65.1 
 
 Other Caucasian 
 
 5 
 
 26.4 
 
 Japanese 
 
 12 
 
 16.3 
 
 Females 
 
 Number 
 
 Rate 
 
 157 
 
 1,419.9 
 
 57 
 
 707.8 
 
 Total 
 
 377 
 
 222.0 
 
 14 
 
 2 
 1 
 
 231 
 
 120.0 
 
 267.6 
 
 Table XXIII 
 
 Leprosy in the Union of South Africa 
 
 Number of Lepers in Institutions, by Color, 1910 to 1918 
 
 Rates per 1,000,000 of Population 
 
 
 
 WHITE — 
 
 
 
 COLORED - 
 
 
 Year 
 
 Population 
 
 Number 
 
 Rate 
 
 Population 
 
 Number 
 
 Rate 
 
 1910 
 
 1,255,545 
 
 144 
 
 114.69 
 
 4,621,531 
 
 1,678 
 
 363.08 
 
 1911 
 
 1,280,381 
 
 155 
 
 121.06 
 
 4,722,720 
 
 1,782 
 
 377.32 
 
 1912 
 
 1,305,217 
 
 184 
 
 140.97 
 
 4,827,114 
 
 2,042 
 
 423.03 
 
 1913 
 
 1,330,053 
 
 190 
 
 142.85 
 
 4,935,027 
 
 2,054 
 
 416.21 
 
 1914 
 
 1,354,889 
 
 186 
 
 137.28 
 
 5,046,585 
 
 2,006 
 
 397.50 
 
 1915 
 
 1,379,725 
 
 187 
 
 135.53 
 
 5,161,950 
 
 2,080 
 
 402.95 
 
 1916 
 
 1,404,561 
 
 193 
 
 137.41 
 
 5,281,266 
 
 2,088 
 
 395.36 
 
 1917 
 
 1,429,397 
 
 186 
 
 130.12 
 
 5,404,707 
 
 2,146 
 
 397.06 
 
 1918 
 
 1,454,232 
 
 175 
 
 120.34 
 
 5,532,455 
 
 2,055 
 
 371.44 
 
 Data from Quarterly Abstract of Union Statistics, Number One, January, 1920. 
 (Office of Census and Statistics, Victoria.) 
 
 51 
 

 
 
 Table XXIV 
 
 
 Leprosy— 
 
 -United Stat 
 
 States 
 
 Alabama 
 Arizona 
 
 
 
 
 1 
 
 
 s a 
 
 
 
 
 Arkansas 
 California 
 
 
 39 
 
 
 
 
 
 
 23 
 
 Colorado 
 
 3 
 
 
 
 
 3 
 
 Connecticut 
 
 5 
 
 
 
 
 1 
 
 Delaware 
 
 
 
 
 
 
 
 
 Florida 
 
 Georgia 
 
 Idaho 
 
 Illinois 
 
 Indiana 
 
 Iowa 
 
 Kansas 
 
 Kentucky 
 
 
 
 2 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 2 
 
 
 
 
 
 Louisiana 
 
 87 
 
 — 
 
 
 87 
 
 Maine 
 Maryland 
 
 
 
 
 
 
 
 
 
 
 
 Massachusetts 
 
 Michigan 
 
 Minnesota 
 
 13 
 
 1 
 
 10 
 
 2 
 
 2 
 
 
 
 
 
 1 
 
 
 Mississippi 
 
 Missouri 
 
 Montana 
 
 Nebraska 
 
 Nevada 
 
 New Hampshire 
 
 New Jersey 
 
 New Mexico 
 
 1 2 
 Information not 
 1 
 
 
 
 
 3 
 
 1 
 
 available 
 1 
 
 
 
 3 
 1 
 
 New York 
 
 28t 
 
 
 
 
 7 
 
 North Carolina 
 North Dakota 
 
 
 1 
 
 
 
 
 
 
 
 
 Ohio 
 
 Oklahoma 
 
 1920^ 
 
 Official (State) provisions for lepers 
 
 Isolation. 
 
 Strict quarantine — deportation to 
 Island for Lepers. (?) 
 
 Not stated. 
 
 Leper colonies at San Francisco, 
 Los Angeles, local isolation. 
 
 Quarantine by county, pending 
 removal to Government Lepro- 
 sarium ! 
 
 State aid — put in isolation hos- 
 pital. 
 
 Quarantined as other communi- 
 cable diseases. 
 
 No provisions for lepers. 
 
 Not stated. 
 
 Isolated at county expense. 
 
 No provisions for lepers. 
 
 Not stated. 
 
 No provisions for lepers. 
 
 State Board of Health would pro- 
 vide in emergency. 
 
 Under State control, isolation, 
 (Louisiana Leper Home.) 
 
 Not stated. 
 
 Leper must be cared for where 
 found. 
 
 Leper Colony at Penikese Island. 
 
 No provisions for lepers. 
 
 Under control of local Board of 
 Health, isolated in own house- 
 hold. 
 
 Not stated. 
 
 Case isolated at county expense. 
 
 No provisions for lepers. 
 
 No provisions for lepers. 
 
 No provisions for lepers. 
 
 No provisions for lepers. 
 
 None other than modified isola- 
 tion at home. 
 
 Every case investigated and diag- 
 nosis made. Isolation. (?) 
 
 Not stated. 
 
 Controlled by local Board of 
 Health. 
 
 Isolated in home especially pre- 
 pared on grounds of Dayton 
 Quarantine Hospital. 
 
 Not stated. 
 
 ♦Results of special inquiry in co-operation with State and local Departments of Health. 
 tNew York City only. 
 
 52 
 
Table XXIV (Continued) 
 
 States 
 
 Number of 
 
 known leperi 
 
 in State 
 
 January 1, 
 
 1920 
 
 "S 
 
 I 
 
 doubtful, 
 
 additional oi 
 
 suspected 
 
 cases 
 
 a 
 
 3 
 
 cases 
 
 officially 
 
 segregated 
 
 during 1919 
 
 Official (State) provisions for lepers 
 
 Oregon 
 
 1 
 
 
 
 
 
 1 
 
 
 Isolation. 
 
 Pennsylvania 
 
 6 
 
 
 
 
 
 — 
 
 
 
 Rhode Island 
 
 
 
 
 
 
 
 
 
 
 No provisions for lepers. 
 
 South Carolina 
 
 2 
 
 
 
 
 
 
 
 
 Not stated. 
 
 South Dakota 
 
 
 
 
 
 
 
 
 
 
 No provisions for lepers. 
 
 Tennessee 
 
 
 
 
 
 
 
 
 
 
 No provisions made. 
 
 Texas 
 
 33 
 
 
 
 
 
 — 
 
 
 Not stated. 
 
 Utah 
 
 
 
 
 
 
 
 
 
 
 None except notification and 
 casual quarantine or segrega- 
 tion. 
 
 Vermont 
 
 
 
 
 
 
 
 
 
 
 Not stated. 
 
 Virginia 
 
 1 
 
 
 
 
 
 1 
 
 
 Cared for by local authorities. 
 
 Washington 
 
 1 
 
 
 
 
 
 1 
 
 
 Isolated. 
 
 West Virginia 
 
 
 
 
 
 
 
 
 
 
 No provisions for lepers. 
 
 Wisconsin 
 
 2 
 
 
 
 
 
 1 
 
 
 Isolated — and attendant provided. 
 
 Wyoming 
 
 
 
 
 
 
 
 
 
 
 Placed in pesthouse same as any 
 other contagious disease. 
 
 Dist. of Columbia 
 
 
 
 
 
 
 
 
 Isolation remote from persons not 
 
 
 
 
 
 
 
 
 having disease. 
 
 Total 
 
 242 
 
 
 7 
 
 
 134 
 
 
 
 Porto Rico 
 
 37 
 
 
 — 
 
 
 — 
 
 
 There is a law for isolation and 
 segregation.* 
 
 *See footnote page 17. 
 
 53 
 
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