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 1889
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WC 335 B638L 1889
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NLM051686665 
 
 
LEPROSY  IN  NEW ORLEANS.
By Henry W. Blanc, M. D., Dermatologist to the Charity Hospital; Lecturer on Der-
  matology, Tufane University ot Louisiana; Instructor in Skin and Venereal Diseases,
  New Orleans Polyclinic; Dermatologist to the Touro Infirmary.
   Leprosy in Louisiana is no new  thing, for  it has long
 been a recognized fact that a few stray  cases  which came
 years ago with the Acadians from Nova Scotia, or as immi-
 grants from the West Indies, have left a taint in the blood
 of their offspring which crops out occasionally, without ap-
 parent provocation, to  maim and afflict the  unfortunate
 victim for a few brief years.   In addition to these it is rea-
 sonable to infer, particularly in the light of several histories
 to that effect, that  a  number of more recent immigrants
 have brought from Western Europe  developed or undevel-
 oped  forms of  leprosy inherited from parents suffering
 from the same disease. And last but  not least in importance
 are  to be found a few cases  with no history of suspicious
 disease in the family which, after coming into known con-
 tact with such persons,  have developed  the  same  disease
 themselves.
   These poor creatures, who are usually among the hum-
 bler classes, having long sought alleviation  without avail,
 have many of them gradually gathered into this great city,
 and  from  time  to time applied for advice and treatment
 at the always opened doors of the Charity Hospital.
   Since the department  for diseases of the skin was organ-
 ized under the supervision of the author in the above men-
 tioned institution,  these patients  have fallen to his  care;
 and, if the total number  of cases reported  seems large, it is
 because they constitute a  majority  of  those now existing
 in the city; but it  may here be remarked that, for the rea-
 son given above, the cases in New Orleans probably large-
 ly outnumber all the rest of those in  Louisiana,  outside of
the parish of Orleans, combined. 
    VC



     <m                2
  In dotting  down  the following  notes  many  difficulties
have been encountered, for the  reticence and ignorance of
patients prolong and confuse inquiry, and  much  time is
expended in gaining their entire confidence.  The necessity
for treating a number in a limited  space  of time requires
that the histories be  taken hastily, and occasionally  the
patients have never returned to  complete their story.  But
oftenest when the facts here reported are incomplete, it is
because the patients' information was exhausted.
  Such as they are, these notes  are given in full as a contri-
bution  to the  study of leprosy, as it is seen in this city, and
with the desire that it  may throw some  light—dim though
it be—upon the  much disputed question of the  mode of
spread of a most repulsive disease.  Believing that leprosy
is propogated in other ways than by hereditary transmission,
it is hoped that this  report will bring about—by the bare
recital  of cases, if for no other stronger reason—an attempt
at segregation of lepers by the community for the benefit ot
both parties  concerned. For it should be remembered that
we have to deal  with a disease which  is as implacable as it
is slow and insidious, and taints the family while it destroys
the individual.
  Like another disease—syphilis, which this  one sometimes
resembles—leprosy has a  number of varieties, the principal
of which are the  tubercular and the anaesthetic;  but as ery-
thema  and pigmentation prevail in  many cases, the desig-
nation  macular has been added or prefixed  to these diag-
noses in order to better describe the lesions of the skin.
  Were it not for the frequent misapplication and mis-
construction of terms among members of the profession it
would  hardly be  necessary to say here  that by the word
leprosy is understood, not the lepra which a few English
writers still persist in applying to certain forms of psoriasis,
a much milder disease; nor yet the elephantiasis Arabum,
which  is a local thickening of the skin, usually of the scro-
tum, or one of the lower  extremities,  and when on the  lat-
ter is known  as the Barbadoes leg.
  What is described here is the elephantiasis of  the Greeks 
                            3

 —the leprosy of the  Hebrews, the Chinese, the Sandwich
 Islanders.  In other words, true leprosy (or lepra), a dis-
 ease consisting of peculiar round-cell deposits in the tissues,
 accompanied by a micro-organism  known as the bacillus
 leprae.
   Additional notes, which make this article more complete,
 have been kindly furnished  by Dr. J. H. Bemiss, who has
 studied this  disease on the Sandwich Islands, and by Dr.
 A. M. Beret, who reports several valuable cases.
   *Case i.   Lepra An^esthetica.—White woman, aged
 60 years.   Native of Germany.  Occupation, cook.  Res-
ident of Third District.   Applied at  my clinic in Charity
 Hospital November 12th, 1886, and  admitted to ward the
 following year.
   Family.—Mother died of consumption.  Cause of fath-
 er's death unknown.  Has several sisters and brothers, but
 none have a disease like hers.  Is a widow; husband died
 n years ago.  Cause  of  death  unknown.  Has had five
 children—all died young except  one, who is in an insane
 asylum.  Lived at present residence 6 years.  Disease be-
 gan a year ago with  weakness and numbness of fingers,
 hands feeling as if she had on gloves.  Bowels costive.
   Condition on Examination.—Erythema and swelling of
 face.   No tubercles on face, the redness passing gradually
 into healthy tissues.  Features are not deformed  and are
 normal in shape  and function.  Very nervous expression
 about the eyes.  All  rest of body normal except hands,
 lower part of legs and feet.  The hands are red, smooth
 and swollen.   Fingers  stiff, and  several knuckles covered
 with scales.  Warts on distal phalanges of first two fingers
 of right hand.  Lower half of legs pigmented, scaly and
 cedematous.   Feet red and swollen.   Ulcer, deep and in-
 dolent, on inner surface left foot,  size of silver half-dollar.
 Has varicose veins on legs and thighs.
  Sensation.—Diminished all  over face,  and absent on
 malar prominences.  Diminished on neck.
* Al] of these cases have been observed during the past five years. 
4
   Rioht Upper Extremity.—Diminished all over, and en-
tirely absent on fingers, back of hands, and a band 2 inches
wide about wrist.
   Left Upper Extremity.—Diminished  everywhere,  par-
ticularly on forearm, and entirely absent on ringers (with
exception of second), back of  hand and over lower por-
tion of ulna.
   Trunk.—Slightly diminished everywhere,
   Left Lower Extremity.—Nearly normal  on thigh, but
diminishes downward from just below the knee.  A circle
of  anaesthesia,  2  inches in diameter,  surrounds the ulcer
on this foot.  A pin or knife stuck into this patch draws
dark blood, but there is no sensation.
   Right Lower Extremity.—Same as left, except that an-
aesthesia is not complete on foot.
   Says that bed-bugs frequently sting her, but she never
knows it unless it be upon the face.
   This patient  was given chaulmoogra  oil  with  benefit.
Iodoform salve  caused ulcer to heal, and in two months a
vast improvement of general  health  was noticed.   She
stopped the oil and immediately  got  worse ; resumed it
and improved.  Is now in the hospital (August, 1888) for
the third time, and is kept there, as she  always stops  the
medicine when she goes  out.  A year ago  she  had an
ulceration of left little toe, and  lost a piece of  bone.   She
now has   no  ulcers, has  gained  flesh, and  looks  well.
Erythema of face  has  faded  away.   The chaulmoogra
regulates  the  bowels.  Dose:  Thirty-five  drops  in milk
three times a day.

  Case 2.  Lepra Tuberculosa.—White boy,  a«-ed 16
years, native  of New Orleans, resident of Third District.
  An out-door patient of Charity Hospital (service of Dr.
Parham)  since February, 1886.  Seen  first by me Novem-
ber, 1886, when  these notes were begun.   Taking  now
(November, 1886) fifteen drops of chaulmoogra oil  three
times a day, and declares that he has greatly improved
under treatment, as feet were formerly very sore, " face 
0
had more bumps," and right  ear had scabs upon it.  The
knee was sore and is now well.
  Previous History.—No history of disease in family.  Is
accompanied by a  younger brother who  has a strumous
look.
  In May, 1884, patient first noticed small tubercles on or
about nose, and two months after the ears became thickened
and nodulated.  These symptoms were increasing up to
February, 1886, when  he applied at the hospital with the
favorable results already noted.
  Condition  on Examination.  — Skin  naturally  dark—
thickened on face.  Nose slightly enlarged at alee.  Lobes
of ears enlarged and  nodulated.   Ears large and promi-
nent.   Trunk has  mottled  appearance.  No  tubercles.
Skin  of forearms  and hands  thickened,  and tubercular
nodes on back of forearms.  Finger-nails  normal.
  Here and  there  on  legs are  a few  brownish patches.
Toes are  smooth,  red and shiny.  Minute  ulcer  on left
great toe at root of  nail.
  Sensation.—Partial  anaesthesia over tubercles of fore-
arms and back of hands.
  Sensation diminished everywhere on hands and feet, but
most marked on fingers and toes ;  though analgesia is not
complete anywhere except on little finger of left hand.
  Chaulmoogra oil was continued, and patient made steady
progress.  A note  made in  October, 1887,  declared that
sensation was present everywhere and that no more ulcers
remained on  the toes.
  Case 3. Lepra Maculo-An^esthetica.—White woman
aged  35.   Native  of  Germany, but  a resident of New
Orleans since  childhood.  Occupation, cook.   Resident
of Sixth District.
  Appeared for treatment  in  my  service  at the  Charity
Hospital, Nov. 6, 1886.
  No history of family disease.  Father died of alcoholism.
Patient is a widow, her husband having recently  died  in
this hospital of spinal sclerosis.   Resided in  Houma, La., 
6
for a year and a half, and left there in 1881.  While at this
place she lived  principally  on  salt  meat, and  contracted
dysentery, which lasted off and on for six months.  While
in Houma she noticed a white spot on the inner surface of
the lower third  of left  leg.  This gradually increased in
size, but gave no trouble.  Has been subject to neuralgia
of the right side of the  face, but the attacks  have  ceased
for the past four years.   About six  months ago spots ap-
peared on the left arm, and the face began to swell. Thinks
the burning sensation of the face due to standing too near
the stove, though she has noticed that the face flushes very
■easily when she  walks or otherwise  exerts herself.
  Present Condition.—Has a numb  feeling along the  dis-
tribution of the right ulnar nerve, particularly  in  the little
finger, " as if it were asleep."  Complains of a chilly sensa-
tion nearly every evening, after  which  she occasionally
perspires from the hairy scalp, and nowhere  else, the hair
becoming very  damp.   Has  not menstruated in  nearly
two months.   Is of blonde complexion.
  Head.—Face  is flushed and  swollen,  and  itches  con-
stantly, " as if ants were walking over it."  There  are  no
circumscribed tubercles, but skin is thickened  over the
eyes and prominent.  Nose enlarged. Throat normal, and
all of the senses except that of touch are good.
  Brown pigmentation on left side of neck. Trunk slightly
pigmented, otherwise normal.
  Upper Extremities.—Skin of arms  covered with tan-
colored plaques, circular in  shape,  and pale  in  centre.
These are from  one to four inches  in diameter.  Skin of
hands thickened.  Occasionally has  a tingling sensation in
right arm as on the face.
  Lower Extremities.—Legs are pigmented from just above
knees, and  on lower third of left  leg is a patch of pure
white skin.   This nearly encircles the limb, and  is very
clear-cut, and well defined, forming a  marked contrast
with the  bronze, ichthyosis-like pigmentation surrounding
it. The size of this leucodermic spot is about five by seven
inches. 
i
  Sensation.—Face, neck and trunk normal.  Diminished
on pigmented plaques of upper extremities, and about little
finger, but experiences pain here if pierced with a pin.
  On the lower extremities the anaesthesia is more marked,
being  confined on the left leg to the white spot,  where
analgesia is almost complete.   On greater part of the sur-
face patient cannot distinguish points two inches apart.
  Chaulmoogra oil was given at the start, but as progress
was not notable,  Unna's ichthyol treatment was  resorted
to.   Applied as a 50  per cent, salve, it caused  the face to
peel, and simply aggravated  the  disease.  The salve was
used again in three trials of four weeks each, the percent-
age being gradually diminished to four per cent., with no
visible results.  In  the meantime pills were given—a grain
and a half three times a day.  It should be  stated that an
interval  was allowed after each  application had done its
work, and the tissues permitted to take on  a more natural
aspect.
  Chaulmoogra oil  disagrees  with her,  but whenever taken
it seems  to prove beneficial.
  Case 4.  Lepra Tuberculosa.—Patient sent  to me by
Dr. Castellanos.   White  man, aged 29  years.   Resident
of  the Second District.   Has been a  cigar-maker for  the
past ten years.
  Father died in  1871  of "liver  disease," and had no
affection of the skin.  Mother still living; is 54 years old,
and perfectly  healthy.
  Knew one of his grandfathers, who had no skin disease,
and a grandmother, now 89  years old, enjoys pretty good
health.  Has  one  sister and seven brothers living, who
have no disease that he is aware of.  A sister and brother
died in early childhood—one of them having had lock-jaw;
the other died at  the age of three months.   Patient is mar-
ried to a healthy  woman, and is the  father of three healthy
children,  the  eldest being  seven  and the youngest two
years old.  He has lost one child, coming next to the one
seven  years old, which  died of pleurisy—making four 
8
 children in all.   Wife never had any miscarriages.  Patient
 was born  on Washington  avenue, in the Third District,
 and has never left the city but twice in his life.  In 1879
 he spent a short time in Pensacola, and was in Chicago for
 a while in 1884.  The disease began (was noticed) three
 months after his return from Chicago.
  Has never had any venereal disease, and never knew
 any one with a  disease like his.  Seldom eats  pork,   but
 eats salt meat  occasionally.  Had chills and fever fifteen
 years ago, and  has had dengue and some other fever since
 present disease began.
  The first appearance of the disease was in the form of
 reddish rings,  "like  ringworm,"  on the right   forearm,
 followed by swelling of the hand.  Then came swelling of
 both hands, followed by anaesthesia,  with swelling  of  the
 face and pigmentation  of the body.   Says that  when he
 would scratch  the plaques his  sensation was very much
 benumbed.
  Notices  numbness   of fingers when  he  rolls cigars
 Hands are often very cold in summer as well as in winter.
  Has taken chaulmoogra oil for a short  time, in five-drop
 doses.
  Condition on Examination.—General health  moderate-
ly good.  Complexion  naturally quite dark.  Face covered
with tubercles of a dirty red color, particularly  about the
eye-brows  (which  are very scanty), the  ears and   the
mouth.  The ears are studded with small tubercles over a
much thickened skin,  and are distorted from  their normal
shape.  The roughness of the  forehead ceases  abruptly
in  an arch  of  smooth  skin, half  an inch in  diameter,
on  the edge  of the scalp.  Nose is  thickened,  but
presents no special tubercular  deposit.  Tongue normal,
but uvula is short, thick and red. The pillars of the fauces
are abnormally  red.
  The  trunk is much discolored  with irregular, dark
blotches, which  extend on to the  arms ; while  the fore-
arms are covered with tubercles of a dark, red color.  The
skin of the hands is slightly thickened, and is smooth, but
 not anaesthetic. 
9
  The lower extremities present no abnormality of shape,
but a pigmented and rough skin, resembling xeroderma, is
marked just below  the knee.
  Tested  with a pointed instrument, no anaesthesia could
be detected anywhere except about the inner edges of the
palms in the distribution of the ulnar nerve.
  Case 5.  Lepra Tuberculosa.—White woman,  aged
25 years,  native of  St. Louis, Mo.; but has lived in New
Orleans since  childhood.  Applied for  treatment in my
service at the Charity Hospital, July 21, 1887.   Father is
healthy; mother died of consumption.  All her sisters and
brothers died young—cause unknown.  No living relatives
except husband and two children. Information comes from
another source  that the  husband  of patient has suffered
severely  with   syphilis,  and that  he  gave  this  disease
(syphilis) to his wife.
  Has two healthy children, and has lost one with measles.
Patient enjoyed good health until the  birth of  first child,
when a "  bruised "  eruption  appeared on face accompanied
by  "lumps " on the arms.   This was seven years ago, and
the patient had been living in the same house in the Second
District for four years.   She has  just moved  from  this
house, after a residence there for  eleven years.   Lives at
home and takes care  of  her  children.  There  are seven
persons on the  same lot.   General health is good.  Never
has chills, but formerly suffered from fever. Eats fish very
seldom, and ate salt meat a  great  deal about the time she
was taken sick.  Nurses her own children.  Says that skin
was very sensitive about two years  ago.
  Condition on Examination.—Voice hoarse, eyebrows al-
most entirely gone,  eyelashes scanty.  Complains of a sen-
sation of a film  being constantly over the eyes.   Thicken-
ing of skin of face  everywhere,  particularly in  region of
eyebrows.  A few small tubercles on the lobes of the ears;
one tubercle, size of a pea,  on  edge of  upper lip.  Chin
somewhat puckered,  eyelids heavy and  waxy, and upper
lip  thick  and prominent.   The integument is  darkened 
10
over the whole body, and, in places,  of  a dirty, mottled
hue.  Tubercles have been more numerous, but a few are
still seen upon the  trunk  and forearms.   The hands and
fingers are thickened, more especially near the nails, which
are normal in appearance.  Feet are  swollen, toes thick-
ened and of bluish-red color.  Toe-nails normal in shape.
   Sensation.—Not  entirely absent anywhere.   Natural on
the face, slightly diminished on  hands about ulnar nerve
distribution (where she has  occasional pains), and most
diminished about lower part of legs and outer surfaces of
feet.
   Icththyol pills were ordered (gr. jss), but it is uncertain
whether she ever took the medicine.
   Case 6. Lepra Maculo-Tuberculosa.—The following
history  is drawn  from the records made at  the  hospital,
where the patient applied in my service, July 12th, 1887,
and from notes furnished me  by Dr. Bemiss, which were
taken in August, 1884.
   White woman, aged (1887), 26  years;  native of New
Orleans, and resident of First District; occupation, house-
maid; unmarried.
   Family History.—Parents both born in  Ireland.  Both
dead—mother about 18 years, father about  20 years.  The
latter died of a fever.   Has one  sister and two brothers,
who are all healthy.  No disease of the kind ever existed
in family.   Has  an aunt, who is married  and has  healthy
children.  Never saw anybody with this disease.
   Habits.—Eats very little meat and vegetables. Appetite,
poor.  Likes  coffee and  tea,  and  is fond of salt meat.
Never eats fish.   Has recently been employed in a fami-
ly of six persons in First District, where everything is clean
and in good  sanitary condition.   No  one in this family
has the disease.   Her own residence in  the First District is
in bad condition.   The walls are damp and gutters filled
with refuse  matter, but the drinking water is good.  Has
occasional attacks  of chills and  fever, which are never
followed by  the sweating stage. 
11
   Was in House of Good Shepherd nearly seven years ago,
 and while there took pills for fever.  Was removed to Char-
 ity  Hospital, where the doctor said the pills had upset
 "her.
   While in the House of Good Shepherd there was no ap-
 pearance of the trouble, but her sister noticed that her face
 was affected ten  days  after admission into  hospital.  The
 disease appeared in the form of little red "pimples" on the
 face and  hands, and then extended to the upper part of the
 chest.  Hearing and  eyesight have always  been good.
 Gives very muddy history.  Hair is falling out.
   Present  Condition   (July,  1887).—Height about five
 feet;  weight, 93  pounds;  hair,  brown;  eyes,  brown;
 skin, copper-colored;  ears redder than rest of skin.  Skin
 of whole  face  hypertrophied  and   infiltrated, especially
 that of brow, nose, malar region,  lips, chin, cheeks and
 ears.  Discoloration gradually fades towards neck.  Skin
 of trunk  covered with brownish macules.  Skin of hands
 ■discolored, thin  and  shiny, displaying many dilated capil-
 laries.  Nails thin  and friable.
   Large elevated brown patches over whole of back part
 of arms which, in places, extend over the joint. Outline of
 these patches is irregular, and  the skin thickly infiltrated.
 The patches  on  the left forearm are much thicker than on
 the  right.   A  desquamating   tubercle  covers  the third
 phalanx of middle finger of right hand.  On the right ankle
 two tubercles have broken down  and left small  ulcers.
 Patient says she  is  better new than at any time in  the past
 two years.   Has been treated at  the hospital from time to
 time since beginning of disease, and  always found relief in
 chaulmoogra  oil.   The eruption never produces itching.
   *Sensation—Hand.—Dorsum  of right, ulnar side, }£;
 radial, ^$.  Dorsum of  left, ulnar,  iT\; radial,  iT3F.
   Fingers.— Palmar surface  right  index,  yi\ same  sur-
 face of left, yi.  Radial surface right ring finger, yi ; same
 surface of left, }£.  Ulnar surface  right ring finger, -g-;
 * Figures represent shortest distance in inches at which two points on surface can be
.distinguished. 
12
 same surface of left, ^$.  Radial  surface of  right little
 finger, yi ; same surface of left, T\.
   Forearm.—Right.  Radial side,  y2\  ulnar side,  s/q.
 Left.  Radial side, £;  ulnar side, £.
   Face.—Right brow, |; left brow, ^.  Right malar re-
 gion, T3¥  ( ?) ; left malar region, f.
   Case 7.  Lepra Tuberculosa.—Mulatto woman, aged
 26 years.  Native  of St. Charles parish, Louisiana.   Ap-
 plied in my service at Charity Hospital, April 30th,  1887.
 Occupation,  washerwoman.  Resides in Sixth District.
   Previous History.—Never  has been vaccinated.  Never
 had small-pox nor any other contagious or epidemic disease,
 except measles.   Eats fish and salt meats.   General health
 was formerly very good.  Moved to New Orleans long be-
 fore disease began.
   Family.—Has been  married for  five  years, and has not
 "worked out" since  then.   Husband  is  healthy.  Two
 children—one four years old, one twenty months old—in-
 spected by me, and found to  be stout and well.  Patient's
 father was an Italian (white), and mother was a  mulattress,
 native of Plaquemines parish.  No family disease.  Never
 had any miscarriages.  Menses regular for last two months,
 but before this went four months without seeing anything.
 Disease began three years ago on left thigh  as a red (pain-
 less) spot which resembled a  bruise. Was sick last Janu-
 ary  with  an  attack beginning with a chill, followed by a
 fever which  lasted two  weeks.  Swelling and disease of
 face came four months after birth of baby (i. e.  16  months
 ago).  The eruption remained red, but the swelling was
 not permanent.  There was  no  burning pain.   Has been
 subject recently to aches in the back and side of the head.
 Throat has been sore five months—the nose about fourteen
 months.
   Condition on Examination.—Face thickened  and red-
 dened with  infiltration and  prominent  tubercles.*  Eye-
brows and lashes have fallen out,  only a few of the latter
   *See lithograph. 
Case 7.-LEPRA TUBERCULOSA. 
 
13
being  left.    Eyelids  swollen and waxy.  Conjunctivae
yellow.  Well-defined and prominent  tubercles cover the
thickened tissues  of  the face, and average the size of  a
pea,  but many  are larger.   They are  most abundant
about  the nose (which is flat and misshapen), the  cheeks,
chin and lips, extending on to the vermilion of the latter,
which are  decidedly enlarged.   The ears,  particularly
the right, are  distorted out of shape by tubercular thick-
ening, most  marked,  however,  at the  lobes, which are
greatly elongated.  Most of the raised tubercles appeared
about  ten months ago.
   A deposit of pigment discolors  the face  and  extends
half way down  the neck.  The mucous  membrane of
the nose is ulcerated.  Voice harsh.   Tubercular  deposit
on hard  and soft  palate.   Tonsils,  uvula and pharynx
subacutely inflamed.  Gums  swollen on  both borders,
and project  out from sides of teeth  as  if the latter had
been  set in a flat surface.  Skin of  arms, forearms and
hands  thickened and sprinkled with flat tubercles.  These
are least numerous on the arms, where the disease is mani-
fested in raised tubercular or  oval patches, paler in center
than at periphery,  and of a coppery hue.   Several excep-
tions are found on left arm,  where two or three  circular
patches have raised dark centers.
   On thighs and legs are pigmented, circular and irregularly
shaped patches, which have pale centers  surrounded by
dark rings that are not raised  above normal skin.
   Sensation.—Normal on  face,  arms, both  thighs  and
right leg.  At  middle third of left leg external to  tibial
spine   is  a spot of  anaesthesia  2x3, and another  spot
same   size  on  internal  malleolus.  Toes are  all normal.
There  is  an  anaethetic spot on left knee, the cicatrix of
a sore  produced four months ago  in scrubbing.
  Patient's general health and  appetite were good and she
was ordered  ichthyol internally and externally.  This wras
continued for a month when she  ceased  to use  it, and
passed out of sight.
   But last June she reappeared, this time  in my clinic at 
14
the Touro Infirmary, bearing in her arms  a newly born
hydrocephalic child.   Patient's nose was now more ulcer-
ated than ever, the tubercles larger, and every  symptom
aggravated.   Chaulmoogra oil was ordered, but it is doubt
ful whether she has taken the medicine.  The child died a
few days afterward.
  Case 8.   Lepra Maculo-Tuberculosa.—White wo-
man, aged 75.  Native of Louisiana.  Resident  of  the
Second District of this city.  Charity Hospital case.  Ap-
plied for treatment May 14th, 1887.  Father died of old
age  (84).  Mother died of consumption.  No history of
family disease. Patient stopped menstruating at age of 29
years, and has never borne children nor had anypain since
then.  Had four  children, two boys and two girls.   A six-
year-old girl died of "sore throat;" a twenty-nine-year-old
son  died of  consumption.   Other  two have  no  similar
trouble.  Five years  ago the patient was a large, stout
woman, weighing 250 pounds;  now she weighs about  140
pounds, or less.   Thinks she was perfectly well up to two
years ago, when the disease appeared which is now to be
described.
  Condition  on  Examination.—Skin of  face thickened
about  cheeks, nose  and  eyebrows,  and, while  red  on
cheeks, is considerably darkened elsewhere.   Lobes of
ears thickened and tuberculated.   There  are many wrin-
kles on the face which are the result of old  age.   The hard
palate is covered with whitish, irregularly shaped patches,
extending forwards over the median line to the teeth,  and
backwards to the uvula and tonsils.   On the body the skin
is  slightly pigmented  in places,  resembling xeroderma.
The hands are swollen, and a few small  tubercles cover
the fingers.   The skin is ulcerated  about  the nails of the
second and third  fingers  of  the right hand and the third
finger of the left.
  Sensation.—Good everywhere, except  on feet, on the
inner surfaces of which it is slightly diminished.
  Chaulmoogra oil was ordered,  but when last seen she
was taking it very irregularly, as it produced diarrhoea. 
15
   Case  9.   Lepra  Maculo-An^esthetica.—Reported
by Dr. Bemiss.  White man, aged 48 years.  Native of
Wurtemberg, Germany.  Came to America in 1854.  First
to  New York, then to  Buffalo, Canada,  Detroit,  Cleve-
land, Cincinnati and  New Orleans, arriving here in 1857.
After coming to New Orleans  made one visit to St. Louis,
Mo.  In Confederate army until fleet came in. Resides
in Fourth District.
   Family.—Parents  dead. Mother  died  of  phthisis—
father of old age.  Two sisters living in Germany.  Both
healthy.  One step-brother, whom he has never seen.  No
history of disease in family.  Occupation, laborer. Smokes.
Chews to excess.  Diet, ordinary.  General health usually
hearty.  Hemorrhoids when young.   Chills  and fever in
1853-54.  Frost-bitten when 13 years of  age.  Had dys-
entery in 1864-5.  In 1870 or  '71 had severe pneumonia.
Has had tape-worm.  Married  in  1863.   Has three  chil-
dren living—four dead.   Wife sickly—bronchitis.
   History of Disease.—In summer time had heat; washed
with soap.   On his leg had some small red pimples, which
disappeared  in  winter.   Four  or five  months ago  had
patches of congested skin upon trunk.   A month ago  had
an attack resembling erysipelas, involving right eye  and
right side of  face.  Lead-wash was applied to this, result-
ing in deposit of  albuminate of lead on cornea.
   Present  Condition.—Height, five feet  seven inches.
Weight,  129—now  119  pounds.  Hair and beard brown,
eyes light.  Face  and neck, from brow to clavicles, of
characteristic copper tint.  Skin  thickened over  same
regions,  but  especially  on brows and malar prominences.
Lost right eye by sloughing of  cornea.  No tubercles on
face or neck.  Tongue  and mucous  membrane of  mouth
pale, with enlarged capillaries here and there.   Papillae of
tongue large and prominent.  Pharynx congested.
   Trunk.—Copper color of neck  gradually fades to uni-
form, large  copper-colored blotches,  general  on  back.
Skin loose and thick.
  Arms.—Mottled  in  same  manner,   but  blotches  are 
16
smaller, passing into  general  dark but not characteristic
color of hand, except palmar surface of tips  of fingers,
which are tense and of dark  pink color.   No tubercles.
Several tortuous venules on chest.
  Legs.—Blotching on chest  extends to knees, but is less
conspicuous below.   Skin  for  most part of tawny hue.
Slight tendency to stagnation of blood in toes.  No tuber-
cles.
  Sensation.—Hand.—Dorsum  of  right,  2;  of left,  3.
Palmar surface right index finger, %;  left, y&.   Outer
surface right ring finger, %; inner surface, %,  Outer
surface left ring finger, % ; inner surface %.  Palmar sur-
face right little finger, T\; left, TV
  Forearm.—Radial side, right,  7;  ulnar side, 9.  Radi-
al side, left, 4^ ; ulnar side, 6%.
  Face.—Brow (supraorbital region),  2.   Malar region,
right, 1%;  left, y&.   Upper lip,  right side, %;  leftside,
y%.  Neck and lower jaw, right.side, % ; left side, ^.
  Legs.—Dorsum of right foot, 3^ ; left foot, 3^.  Out-
er side right leg, 6x/2 ;  inner side,  6.  Outer side left leg,
3;  inner side, 2>%-   Patella.—Left,  1%;  right, 1%.
Great toe inner side, right, \]/2 ;  left, 1^.
  Case 10.  Lepra Tuberculo-An^esthetica.—Reported
by  Dr.  Bemiss.   White  man,  aged 35  years,  born  in
Baden Baden,  Germany.  Came  to  this city  when  2^
years old, and has lived here  ever since.  Father  living,
healthy.  Mother  died about  26 years ago of  cholera.
While patient was still a small child father married again.
This  wife bore the father of the patient two boys, who,
when about 7 and 5 years of age respectively, acquired this
disease and died of it at the ages of 14 and 15.  About
two years after the disease made its appearance in the
boys, their mother was taken with  it, and died of it about
three years ago.
  Patient says that there is no history of disease in his own
family, and that he has two children (boy  and girl) who
are perfectly  healthy.  They were born before he  was 
17
 afflicted with the malady.  Patient has never left the city
 save for brief intervals.   Occupation was that of a boiler-
 maker;  now only does odd, light laboring jobs.   There is
 no one at the shops afflicted with this disease.  Does not
 smoke now.  Chews.  Never was a  drinking man.  No
 venereal  diseases.  Ordinary simple diet.  Seldom eats
 fish.   Was always healthy until 14 years  ago, when he had
 chills  and fever for 18 months in spite of medicine.  Nose
 then  bled  freely  at  slightest touch.   Never subject  to
 epistaxis before.  About four years afterward had first in-
 dications of this disease.
   Present History of Disease.—Broke  out with  large
 yellow spots (some  claret-colored)  scattered  well over
 body, appearing first on  back, then  chest, then generally
 over rest of body.  Were oval in shape, and size of finger
 nail.  (He  thought they were  hives.)  Consulted a physi-
 sician.  These  spots  turned  into  lumps in  substance  of
 skin, but did  not  become confluent.  Disappeared  under
 cuticura, leaving no marks.  Face was same as body as to
 lumps, which left, but skin became thicker.
   Was one time afflicted with neuralgic pains all over body.
 At this time exposure to sun caused skin of face to swell
 and burn.   Was then in a much  worse state than now.
 Does not know when eyebrows fell out.  About four years
 ago large water blisters formed on hands. He broke them,
 leaving deep  ulcers very slow in  healing.  Lost nails at
 same time.  They became thin,  wrinkled and split off.
 About four years ago feet became affected in same  way as
 hands.   Resume:   Ten years ago spots  on  body.  In
 same year "they went into lumps." Face affected at same
time.   Hands and feet about  four years  ago-  Voice be-
 came husky about four years ago.
  Present Condition.—Height, 5 feet, 10 inches.   Weighs
 145 pounds.  Large,  broad-shouldered; was  once  very
strong.  Hair, brown; beard,  light; eyes, blue.
  Skin of face  and neck  has characteristic  copper tint.
That of whole face hypertrophied, especially so over brow,
malar processes, lip and ears.  Nose is flat and broad; very 
18
large folds (bags) under eyes.  Has completely  lost eye-
brows and lashes, and beard is very thin and  straggling.
  Whole  of hard palate  thickened and  studded  with
tubercles.   Pharynx in same state.  Uvula gone; pillars
of fauces distorted; tonsils reduced to scar tissue.  Breath
offensive.   Ears large and infiltrated.   Hearing impaired.
  Body.—Skin  thickened and discolored as far down as
umbilicus, slanting both  anteriorly and  posteriorly  from
shoulders to waist.  If skin is rubbed between fingers there
is a corded or emphysematous feeling imparted. No tuber-
cles.
   Right  Leg.—Patch of discolored scars as large as hand
over  patella.   Skin of lower third much thickened and o
dark-brown color with numerous scars—depressed, shin-
ing, and of a bluish tinge.   Over  inner  malleolus is large
 oval  ulcer, with thick edges surrounded by thick and red-
 dened  skin.   Another ulcer, size of nickel, a little below
 middle point of tibia, healing.  One  a little in front of  out-
 er malleolus.  Another,  three inches above.  Toes puffed,
 shining, and purplish-pink color.  Nails similar to those of
 hands.
   Left Leg.—Condition of left similar to that of right, ex-
 cept that over tendo Achillis, two inches above its insertion,
 is a very large ulcer with thick overhanging edges.
  , Anaesthesia.—Head.—Dorsum of right and  dorsum of
 left,  complete.   Palmar surface  right  index  finger, ^.
 Same of  left index finger, ^ (uncertain).  Radial suface,
 right ring finger,  complete.  Ulnar  surface, same finger,
 complete.  (Produces  involuntary  twitchings.)  Radial
 surface, left ring finger, complete.  Ulnar surface, same
 finger, complete.  Radial  surface, left little  finger,  com-
 plete.  Ulnar surface,  right little finger, complete.
 '  Forearm.—Radial side, left, sensitive to  needles.  Ulnar
side, left,  cannot distinguish points.  Radial  and  ulnar
side, right, same as above.
   Face.—Brow, right and left, cannot  distinguish points.
Malar region, right, y2 ; left, %.  (Better  on left than on 
19
right.)   Upper lip, right, %-, left, y8.  Lower lip, right,
yi ; left, y&.   Neck under lower jaw, right and left, 2.
  Feet and Legs.—Dorsum  right foot, 4 ; left, 4.  Can-
not distinguish points on legs, great toes, or patellae.

  Case ii.  Lepra Tuberculosa.—White woman, aged
47 years.  Born in Louisiana.  Resident of Second Dis-
trict.  Appeared as an out-door patient in my service  at
the Charity Hospital, May 14th, 1887.
  Comes of a well-known Louisiana family.   Father died
fifteen years ago of  chronic  diarrhoea.  Mother  died  of
chronic diarrhoea at the age of 64, but neither parent had
any skin  disease.  Has had  eight  sisters  and brothers,
but three are  dead.   These died of Bright's disease, pa-
ralysis and general debility.  Had a  brother who  had a
disease resembling hers, but he is now well.   Other mem-
bers of the family are  healthy.  Patient is  married and
husband  healthy.  Had  one child, who  died of yellow
fever. Had a miscarriage in 1874. Patient has slight hyper-
trophy of both lobes of the thyroid gland dating back to the
age of 13 years. Has lived in other portions of Louisiana.
  Disease began six years ago  in the bend of the right
elbow as a brownish coloration.   This was unaccompanied
by other symptoms for several months,  when she noticed
that the face  became  red and swollen  (though it did not
burn);  little, spots, like  mosquito bites, appeared on,the
back of the neck, and the brown  blotches spread generally
over the body.
  Condition on Examination.—Skin of face has the color
of a dark brunette, only is somewhat more reddish in hue.
A sister, who accompanies the patient,  declares  that she
was quite fair before the  disease began.   The skin of the
face is thickened, and a few tubercles, which  are  distribu-
ted over the nose, cheeks and chin, have enlarged'capillary
vessels running into them.  The eyebrows are very scanty,
and the skin over the superciliary ridges thickened, impart-
ing a slightly leonine expression.  Eyelids are  heavy; con-
junctivae yellow.  A few tubercles thicken  the lobes of the 
20
 ears.  Patient  has a sensation, more  or less constant, of
 having a " cold."  Voice is hoarse, and there is a tuberc-
 ular deposit on  the soft palate  and uvula.   Trunk has a
 dark mottled hue.  Forearms and back  of hands covered
 with small red  tubercles.  Hands are smooth and swollen.
 Finger nails  natural.  Small  tubercles on legs  and feet.
 Feet are  scaly and  red  on  inner surfaces.   A few small
 ulcers of  irregular shape  are  seen on  the  feet and lower
 portion of legs.   Hands and  feet  always "feel as if they
 were asleep."  If patient is  suddenly struck  or jolted she
 experiences an acute pain.
   Pills of ichthyol, a grain  and a  half each,  were ordered
 to be taken three times  a day, and  an ointment of equal
 parts of vaseline and ichthyol  applied to the face.  During
 the two succeeding months  these were used  steadily, but
 patient gradually weakened, becoming greatly prostrated in
 the middle of July.   Superficial  ulcers,  which formed on
 the soles of the feet, were treated locally, and the ichthyol
 preparations discontinued in favor of iron and cinchona.
   I saw her last on August 4th, 1887, when   it was noted
 that the patient was  complaining  of  constant  and extraor-
 dinary diaphoresis.  In my absence from the city  she came
 under the care of a well-known physician, who treated her
 until her death  in December,  1887, the diagnosis on the
 deajh-certificate being, "blood-poison."      •
  Case 12. Lepra Maculo-Anvesthetica.—White man,
 aged 46 years.   Native of Austria.  Shoemaker by trade.
 Resident of the Second District.   Applied in the  out-door
 clinic of  my service  at the Charity Hospital, March 24th,
 1888, when the following facts were elicited:  Has been
in America twenty-eight  years, living most of this time in
 New Orleans.  Father died in an insane asylum ; mother
 died at  " change of life."  Has  had sisters and  brothers
 (five in number), all of whom died young; causes unknown.
Has an uncle who is subject  to fits.   Has been  married
eighteen  years, living all of  that time in this city.  His 
Case 12.—LEPRA MACULO-AN^STHETICA. 
 
21
 wife and four living children are healthy.*  Has lost three
 children : a baby, three weeks old, died of bronchitis; an
 older child, of yellow fever in 1878; and one, nine months
 old, of  marasmus.  Disease  appeared  nine or ten  years
 ago, while patient was living in the Third District, but he
 never knew any one with a similar complaint.  Has never
 been fond of fish, and only  ate salt meat once a week  at
 the time that the disease began.  Disease first gave trouble
 as a soreness of the right  ear along  the helix, which was
 scratched,  and  in a short time produced  loss of tissue.
 The helix having been destroyed, the  parts healed rapidly.
 The nose and  left ear then became similarly affected, and
 with the same result—i. e., loss of tissue.   There seems to
 have been  undoubted  itching  accompanying this process.
 The ulceration of  the nose began within the nostril.  The
 disease first manifested itself in the shape of red circular
 patches  on the left forearm, which were thought to be ring-
 worm.   Iodine was applied to these ineffectually.  At the
 time of the ulceration referred to the face began to get red,
 and the patches to  appear  on other parts of  the  body.
 Has never had any venereal disease.
   Condition on Examination.—Head.—Face is erythema-
 tous in symmetrically arranged patches which are slightly
 raised above the normal skin, leaving small  surfaces of
 health)'  skin in the median line of the  forehead  to within
 one  inch of the  bridge of the nose.  The skin is likewise
 healthy on the  eyelid, jus  below the eyes, and on the chin.
 The eyebrows are thick and the conjunctivae normal. The
 anterior  portions of the alae  nasi are cut out as if with a
 knife, in straight, V-shaped incisions, one on either side.*
 The septum nasi is perforated by a hole the size of a dime,
 but  the  sense of  smell  is not destroyed.  There is no
 soreness about either the nose or the ears, but the. latter
 look flattened from the absence of their helices; otherivise
 they  are natural.  The  pharynx  is  erythematous; the
 * The wife and three children called on me subsequently for examination, and were
found perfectly sound.
  *See accompanying lithograph. 
22
tongue normal.   No disease is  perceptible on the scalp.
A few irregular, red patches are scattered over the neck.
  Trunk.—The  anterior  surface  is  covered with  three
large  patches, oval in shape  and  of a  yellowish-red color.
These are slightly  raised above  the surrounding  skin,
whiter in the  centre than normal  integument, and  are not
very distinctly outlined.  These  patches  or rings  average
six  inches  in  diameter, and are situated  one on either
breast, inclosing the nipples, and the third, more irregularly
shaped, is on the left side  of the abdomen, being limited
on the right border  by the median line at the umbilicus.
None of these patches cross  the median line, while all three
are  limited by it.  On the back they are more numerous
and more oval in shape, though  smaller,  and seem to con-
form to the obliquity of the  ribs, and the  general direction
of the spinal  nerves.   They have the same characteristics
as those on the anterior surface,  but are redder, and more
clearly defined.
  Upper Extremities.—As  on  the trunk,  there  are like-
wise ringed patches on the upper extremities, more partic-
ularly the left, where the rings are large and cover nearly
the  whole surface.  The right arm is normal, but the fore-
arm has ringed patches.  The  right  hand  is very thin at
the  metacarpus, and the third and fourth fingers are per-
manently flexed.  There is a large bleb on  the inner side
of the palm,  near the wrist.   The nails are  normal.   The
fingers of the left hand are  congested and swollen, partic-
ularly about  the  joints.  The thumb has lost a bone (re-
moved by a surgeon), but a deformed nail  projects from
the  distal extremity.   On the outer portion of the second
phalanx of the little finger is a deep fissure,  which extends
through the skin and nearly exposes the bone.  This comes
from drawing waxed threads over the surface while sewing
shoes.  There are several broken blebs on the inside of
the  palm.
  Lower Extremities.—A large plaque  completely covers
the  left knee, while a number of smaller ones are spread 
23
 over both legs.   The  feet are not ulcerated, but are very
 red and tender.  It may be said that, as a general rule, the
 patches on the  extremities  are scaly, while those on the
 trunk are smooth.
   Sensation.-Slight anaesthesia of face  (on the red spots)
 and on the trunk.  Both hands have diminished sensation
 and a pin stuck deep into the back or palm  of left hand
 can be felt, but gives very  little pain (analgesia).  The
 feet are anaesthetic on  their outer and inner surfaces
   Urine  examined and found to be normal.   Patient  was
 ordered to  take chaulmoogra oil,  ten drops three times a
 day after meals.   This  was  increased  in  four weeks to
 twenty drops  at a  dose, when a burning sensation of the
 skin was  complained of.  An attempt to diminish  the dose
 was  resisted  by  the  patient, who declared that he  felt
 better, and seemed to prefer this new state of things to the
 former one, in which sensation was  diminished.  At  this
 time a large blister in the right hand was noticed as the re-
 sult of pressure from a walking-stick.
   At the  date of writing (July 29th) the patient's general
 condition is changed decidedly  for the better.  His appe-
 tite is good, his bowels regulated by the oil, and his spirits
 are much brighter.  He  is  now taking  thirty drops at  a
 dose.   Sensation has  changed everywhere, except on the
 hands and feet (which are  improved), from  anaesthesia to
 hyperaesthesia,  and he fears  to remove  his  shirt  lest  his
 bare body should be inadvertently touched.
   Case  13.   Lepra  Tuberculo-An^estketica.— White
 man, aged 27 years.  Native of New Orleans.  Resides in
 the Third District.   Applied for treatment  at  the Charity
 Hospital March 15th, 1888.
   Family History.—Father died of malarial fever.  Moth-
 er is rheumatic, but otherwise in good health.  Both  pa-
 rents born in  Ireland.   Mother's  mother still alive and
 well.   Has a  sister and brother who are healthy.  The
latter is married and has one child.
   Previous History.—-Had never been outside of New  Or- 
24
leans previous to the beginning of the  disease, which was
first noticed fourteen years ago.  Formerly ate a great deal
of salt meat, mackerel, etc.   Prefers salted to fresh fish.
Never had dysentery and never had chills and fever be-
fore  the disease  manifested itself.  The disease has pro-
gressed slowly up to its present stage,  the patient having
noticed a swelling  of the  feet  as  the first symptom, and,
from time to time,  an alteration of pigment and sensation
accompanying yellowish-red   patches  of  the  cheeks and
chin.  He complains of the constant appearance of " blis-
ters "' on the fingers, which  burst and leave small ulcers.
These  ulcers heal  rapidly and  are painless.   Has been
seriously burned twice:  once,  13 years ago,  he  scalded
both arms with hot water, but  this gave little pain;  anoth-
er time, 2 years  ago, his left  leg  came in contact with  a
steam pipe,  which  scalded it  deeply, but gave very little
pain, and healed in about 6 weeks,  leaving a  long  linear
scar.
   Condition on  Examination.—The skin  of the  face is
much thickened and abnormally dark, being wrinkled like
that of a very old man.  Ears  thickened, but not tubercu-
lated.  There are no distinct tubercles on the face, but trie
nose appears deflected to the left from atrophy of one side
and hypertrophy of the other.   Entire absence of eyebrows
and eyelashes.   There is an inflammation in the right eye
(conjunctivitis), which is being treated by the oculist of
the hosoital.  The thick, red and corrugated skin  about
the superciliary ridges gives the face  a wild and typically
leonine  expression.  The papillae of the  tongue  (fungi-
form) are enlarged, but there are no  fissures.  The soft
palate and pharynx are erythematous.  The voice is ex-
ceedingly  harsh.  There is general discoloration of the skin
of the trunk, but no circumscribed patches are noticeable.
Here and there the yellowish-brown color of the pigmenta-
tion  is  of a deep  shade,  being  darkest on the anterior
surfaces.  The  upper  extremities  are covered  with  a
brownish  discoloration.  Hands are thickened in  every 
25
part, presenting the appearance of deep congestion.  Allu-
sion has already been made to the scars from burns on the
arms and left leg.  The lower extremities  are  discolored
everywhere, but ill-defined blotches of pigmentation, deep-
er than the rest, occupy the middle of the anterior surface
of  the  thigh.   The feet are  swollen and darker than the
legs, and at the ball of  the right foot are several ulcers the
size of a butter-bean.  These give no pain.
   Sensation.—Sensation of the face, tested with the point
of a pin, was normal, but slightly diminished on anterior
surface of neck.  Trunk  normal  everywhere  except be-
tween the shoulders, where it is slightly diminished  over a
space four  inches  square. Sensation begins to  diminish
in the middle third of the  thigh, particularly o^er the pig-
mented  portions, and this diminution becomes more marked
in a downward  direction  over the  knees and  legs until,
arriving at the feet, it is entirely absent, with the exception
of a  sensitive  spot on  either heel  behind the  malleoli.
Anaesthesia is so complete on the feet that a pin pressed
one-third of an inch through  the skin, imparts no  sensa-
tion.  A very dark blood exudes from these wounds.  The
genital organs are normal in sensation and color.  The hair
upon the head and pubis  is  normal, and has never fallen
out.  The patient denies having had venereal disease,  and
there are no symptoms  now present to contradict his state-
ment.  Bowels  are not regular,  though appetite  is good.
  I  saw the patient  but twice and  cannot say if he con-
tinued to use the chaulmoogra oil prescribed for him.

  Case  14.  Lepra Maculosa.—White man, aged  35
years ; native of New Orleans, and  has  lived here  all his
life.  Applied as out-door  patient in my service at Charity
Hospital, January 27th,  1887.   Resident of Third District.
Occupation broommaker.
  Family.—Parents had no  similar trouble. Both  dead.
One brother living—healthy.
  Diet.—Frequently  eats,  but  does  not  care a great deaL
for, salt  meat or fish. 
26
  Previous History.—Disease  first  appeared on  middle
third of left thigh eighteen months ago in form of nodes,
which  soon were  noticed on face, upper extremities and
trunk.
  Condition on Examination.—Has a raised, erythematous
patch on right side of forehead.  This is ill-defined at pe-
riphery, but seems to be the result of  confluence of two red-
dish-yellow rings.  Nose  red  and infiltrated, but  not de-
formed.  Red oval patches on both cheeks, the one on the
left continuing down on neck.  Left ear normal. Right ear
red, but not swollen nor tuberculated.   On dorsal surface
of trunk are two rings a  little larger than a  silver dollar,
about same size and coppery red.  Patient thought for some
time that they were  ringworm.   On the sternum and  at
sterno-clavicular junction are several  red rings, which have
grown  together.   On right arm is  a red circular patch with
pale centre, and on the middle  third of right forearm is a
similar patch, but paler.  Patient's general condition fair;
appetite good and bowels regular.
  Sensation.—Normal  everywhere except in  centre of an
oval ring, i% inches in its long diameter, situated over the
sternum, where it is diminished  almost to complete an-
algesia.
  Treatment.—Chaulmoogra and cod liver oil.

  Case 15. Lepra Maculo-An^sthetica.— White man,
aged 65 years, native of  Ireland, and resident of this city
for the past forty years.  Applied for treatment as an out-
door patient  in my service at the Charity Hospital, May
22d, 1888.   Resident of  First District.
  Previous History.— Has  had  venereal sores  several
times—gonorrhoea and buboes.   Never had eruption until
this one came on.  Never had rheumatism.   Has not been
out of  the city for ten years.   Never in country parishes
Occupation,  tailor.
  Family.—Father died  at  the  age  of 50  years.   Had
asthma.  Mother died at the age  of  65 years.  Cause un-
known.  Knew only one sister, who is now dead.   Cause 
•                         27

unknown, but was not a skin disease.  Patient's wife died
of cancer ten years  ago.   Has  four  living children (all
healthy) and eight grandchildren (all healthy).  WTife had
several miscarriages,  but  never lost  children brought to
term.  Lives with his children.
  Diet.—Fats very little salt meat now, though he formerly
was fond of it.  Eats fresh fish on Fridays and other days.
   Condition on Examination.—On right side of forehead
is  an  ill-defined,  raised,  rose-colored  patch,  covering
nearly all of the region from median line to temple.  Paler
at centre than at periphery.   On left of median  line, just
above region of eyebrow, are two patches of same  color,
the size of a silver 25-cent piece and a nickel 5-cent piece
respectively.  Scalp normal.  Throat and tongue normal.
On  left  side of neck is an oblong  patch, red  and  thick-
ened, which is two inches  in diameter  and located over
sterno-cleido-mastoid muscle.
   Trunk.—Two inches to left of right nipple is a patch the
size of a silver half-dollar,  ill-defined, flat, pale in centre.
A smaller irregular patch to left of umbilicus.   The re-
mainder of  the anterior surface of the trunk is normal,
but on the back,  just  above the right gluteal region, is a
large patch, fifteen inches long by twelve wide, which ex-
tends  from the crest of the ilium to the thigh.   It is of a
dark red color, with a pale  centre  and scaly edge.   Be-
sides this, three  ringed patches, oval in shape  and about
two inches in diameter, occupy the back in  the  region of
the kidneys.
   Upper Extremities.—Normal above the elbow.  On the
right elbow and back of  wrist are ham-colored, oval
patches,  with pale  centres.  A scaly  patch, seven inches
long, covers the ulnar and posterior side of the left forearm.
A ring the size of a silver dollar occupies the anterior sur-
face at middle third.   Left hand normal.   Forefinger of
right hand smooth  and red.   A small, ham-colored  patch
near root of forefinger.  Skin of genital organs normal.
  Lower Extremities.—A dark-brown patch, more or less 
circular in shape, size of palm of hand, covers the centre of
anterior surface of right thigh.  Covering completely the
lower half of anterior surface of left thigh is a yellowish-
brown patch, pale in centre, with a scaly border.   Ringed
patch, two inches in diameter, on right knee.   Right leg
normal;  left leg  nearly covered its whole  length with a
scaly, deep-red patch, well  defined in places  and resem-
bling psoriasis.  Right foot normal, but left  has  same sort
of irregularly shaped patches on outer surface as on leg.
   Sensation.—Healthy tissue of face normal, but diminished
on red patch over right side  of  forehead.  Diminished on
the patches which cover the trunk, arms  and legs.  Anaes-
thesia nearly complete in the patch on left forearm; anaes-
thesia in large patches on legs  and feet, particularly the
one on outer surface of left foot.
   The patient has been  doing  well on increasing doses  of
chaulmoogra oil, nothing new having developed during the
course of treatment but the occasional appearance of blebs
upon the fingers.

   Case 16,  Lepra Tuberculosa.—White boy, aged 10.
Native of New Orleans.  Applied in my service at  Charity
Hospital, January 7th, 1887.  Attends  school.   Born  half
a square away from present residence in Third District.
Never been out of  town.  Accompanied by parents, who
are healthy.  Father is a German.  Mother's father came
from  Germany.   Has a sister and two brothers, who are
in good  health.   Never had chills and fever.  Was  per-
fectly well up to five years ago, when parents noticed  red-
ness and  swelling about forehead, followed in a year by
yellowish spots on body.  Two years ago a linear ulcera-
tion appeared on left leg, just below knee, due to pressure
from  elastic garter.  The garter  removed, ulcer  healed
slowly under a salve.
   Condition on Examination.—Hair and complexion nat-
urally very dark.  Eyes bluish-gray.   Face red and swoll-
en, and covered with small tubercles, slightly raised above
skin.   Puckered  condition of skin gives boy the  look  of 
a
29
 an old man.   In places on face are small depressed patches,
 two to five  lines in diameter.  Skin  thickest  about eye-
 brows,  forehead and chin.  Ears are tuberculated and
 stand out prominently.  Eyebrows nearly all gone.  Eye-
 lids, particularly lower ones, markedly thickened.  Has
 had nasal catarrh for some months.  Soft palate and uvula
 erythematous, but  show no  deposits.  Tongue  normal.
 Trunk, which is not specially  emaciated, covered with ill-
 defined blotches or  centres of pigmentation of a greenish-
 yellow color.  Linear scars encircle  the knees above and
 below—from former irritation of  garters.   One of these
 ulcerated places is still open.
   Sensation.—Only  anaesthetic  spot  is a  smooth, soft
 shining  patch on right patella,  three  inches in diameter.
 General health good ; bowels regular.  No deformity any-
 where except on head.
   This patient took chaulmoogra oil for  more than a year
 and improvement was notable.  When last  seen the red-
 ness and tubercles  had  disappeared,  and  only the " old
 man "  look remained, from the  thickened skin.

   Case 17.   Lepra An^esthetica.—White man, aged 62
 years.  Native of Germany, and a resident of this city for
 over twenty years; Second District.   Admitted into  my
 service at the Charity Hospital (ward 27), March 10th,
 1887.   Patient is now in reduced  circumstances, but was
 formerly very well to do.  Has  had present disease about
 eighteen months, beginning with numerous  red  plaques,
 scattered over the  surface of body.   Patient was treated
 by a physician,  and these disappeared in the course of
 three months.  Blebs first  noticed on hand nine months
 ago.
   Habits.—Has been a hard drinker up to one  year ago.
 Eats fish and salt  meat occasionally.  Never had chills and
fever.   Is subject to asthma.  Has had yellow fever.  No
venereal disease.  No history of disease in family.  Has
healthy children.
   Condition on  Examination.—Superficial  blood-vessels 
30
of nose can be distinctly outlined, and are  much dilated.
No marks on face, but outer half of  eyebrows fallen out.
Skin of this region thickened.  Tongue  coated, furrowed
and denuded of epithelia.  Throat normal.  Trunk mot-
tled.  Skin over sternum reddened.  Has  a fatty  tumor
below left nipple.  Fingers of both hands reddened and
covered with glistening skin.  Nails  friable,  and  almost
completely absent on  forefingers.  Irregularly shaped, red
and thickened patches under surface left wrist.   Skin  of
both arms pigmented and  scaly.  Toes are affected like
the fingers.   The right great toe overlaps the others. Legs
are affected like the arms, only more scaly.
  Sensation.—Diminished over  dorsal  surface  of  trunk,
more particularly the gluteal regions, also on forearms and
legs.  The plaque upon the left wrist is quite anaesthetic,
and blood can be drawn by a pin prick from any portion
of hands without giving pain.
  This  case did not  progress  under chaulmoogra oil,
which he soon was able to take in doses of thirty drops;  on
the contrary, the blebs reappeared on hands and feet, and
an ulcer of one of the small  toes destroyed  the last two
phalanges.  The toe was amputated  without anaesthetics,
for the patient had  frequently struck it upon  surround-
ing objects, and on one occasion  twisted it under his foot
as it hung down, and  experienced no pain  therefrom.
  Under potassium  bromide  and cherry laurel  water the
asthma soon disappeared.  Only improvement from the  oil
was in the fact that the patient  began to  sweat from  all
parts of his body, except hands and feet, which  gave great
relief,  as  he had not  performed this  function visibly for
past two years.
   On June ist two ulcers  appeared on nates, which were
now quite  anaesthetic, the ulcers  being  doubtless  due to
friction in the seated posture.   These were perfectly pain-
less, and rapidly grew to the size of a silver dollar.   Iodo-
form salve was applied with good results.   Urine, exam-
ined from time to time, disclosed nothing  abnormal; spe-
cific gravity ioio; acid.  Tissue  removed  from the toe
contained the bacillus  leprae. 
31
  Case 18. Lepra Tuberculosa.—White man, aged 27;
native of  New Orleans.   Applied in my service at Charity
Hospital,  June nth, 1887.  Was seen on two occasions,
but only the briefest notes could be taken.   They are given
in full. Occupation gardener.  Resident of Third District.
No one in family had similar disease, unless  it be mother,
who died in 1882.*   Has a sister and two  brothers living.
They are healthy.   Disease began  on face just above eye-
brows, and gradually spread over body in form  of soft,
raised tubercles of a reddish color.  Skin of face thickened
between the tubercles, which are still present and quite dis-
tinct in outline.  There  are a few on  the  extremities, but
those on face  are more marked. Capillaries of face dilated.
Throat erythematous and tonsils swollen.
   Sensation.—On left arm is  an  anaesthetic spot size of a
silver dollar.   Says that he has scratched this place until
it bled profusely, but that it did not pain him  either then or
after.  Red  spots  on face bled profusely when cut  by a
barber.   Takes no  medicine,  believing himself incurable.
   Case 19.   Lepra Tuberculo-An^esthetica.—White
woman,  aged 57 years; native of  Germany.  Applied in
my service at the Charity Hospital, April 24th, 1888.  Oc-
cupation, washerwoman.  Resident of the Third District.
Did not know parents,  and knows  nothing of her family.
Been in  New Orleans for  thirty-seven years.  Has never
seen any  one  with a like disease.   Was poisoned with ivy
thirteen years ago, and  her face  became badly swollen.
" Some years ago she was  called  to wash the body of a
person who had died of leprosy, her hands having wounds
on them,  and her  impression is  that she contracted the
disease by inoculation."f  Has been married  twice.   First
husband  died in battle; second husband is alive and well.
Has four healthy children, and  has lost two in  teething.
Last child was born sixteen years ago, and patient has been
sick about eight years.  General  health has been good.
  ♦Reference to records of Board of Health shows that patient's mother died of "ele-
phantiasis," doubtless of the Greek form.
  t Quotation from a report of Dr. A. M. Beret to the Board of Health of Louisiana, 1887. 
32
Never ate much  fish or salt meat.  Food consists chiefly
of  potatoes, cabbage, carrots,  rice, oatmeal and  coffee.
Disease  began upon  the chest in the  shape of rings and
circular plaques, which soon  spread upon the legs.  The
face at the same or shortly afterwards became very red and
swollen.   Has had blebs upon the feet from  time to time.
  The description of  condition on examination was not re-
corded at patient's  first visit, and as she never returned,
this cannot be accurately given.   Suffice  it to say that this
was a mixed case  of macules,  tubercles, and  anaesthetic
spots.  There were no ulcers on the extremities, but a few
denuded surfaces showed the tendency to form blebs.
  Case  20.   Lepra  Maculo-An/esthetica. — White
man, aged 27.  Born in New Orleans. Resident of Fourth
District.   Occupation  laborer.   Applied for treatment in
my service at the Touro Infirmary, June 10th, 1887.
  Family.— Father  died of  apoplexy.  Mother is in an
insane asylum.  Parents born  in Ireland.   Two  sisters
and two  brothers—healthy.  Has  been married.   Wife
died three years ago.
  Previous History.—Has had  venereal diseases  several
times. Was treated by Dr. T.  S. Kennedy two years ago
for secondary syphilis, the eruption being accompanied by
sore  throat,  rheumatism and  fever.   These  symptoms
passed away  for a  time.   During the  past  two years
patient has been working occasionally in the  Teche coun-
try—up and down the bayou.   Became sick about eighteen
months ago, the disease first appearing on the knee like a
blister, and shortly afterwards on  other parts, as  a gyrate,
tan-colored  eruption, somewhat  dashed  with  red  and
slightly raised above surface.   Patient does not remember
to have  seen a similar case.  Sleeps in same  bed with
brother.   Diet not confined to any special kind of food.
  Condition  on  Examination.—Face.—Not  deformed in
any way, though bridge of  nose appears to  be somewhat
thickened.  On cheeks are bands of slightly raised, bright
red patches, irregularly distributed.  The skin and features 
33
elsewhere are normal in appearance.   Tongue normal, but
soft palate,  studded  with pin-head-sized  nodules,  very
smooth and shiny.  Uvula elongated.  Voice harsh.
   Trunk.—Spotted  with  tan-colored  blotches, slightly
raised, ill-defined and of gyrate configuration.   The  skin
between them is normal.
   Upper Extremities.—Same gyrate eruption as on trunk,.
only more accentuated.  On hands and fingers the color is
a deep red, and the disease appears on the knuckles as red
blotches, size of a dime.   On  hypothenar surface of left
hand is a  deeply infiltrated,  bluish-red patch.  A few
broken and unbroken  bullae cover the fingers and palms.
Left little finger flexed  at first interphalangeal joint, where
there is a hard deposit.  Patient states that this condition
has obtained for past six years—long before disease began.
The lump is red and of same color as other leprous de-
posits.
   Lower Extremities.—Have  same gyrate  eruption  as
that seen on  arms.  The peculiar  appearance of these
patches can best be described by saying that they resem-
ble in shape the interstices of an eruption  rather than an
eruption itself, suggesting the  idea. that  the true disease
had been resolved, and that the intervening  tissue had be-
come inflamed instead.   This intervening tissue, which is
normal on arms, is almost milk-white on  the legs in places.
A large bulla is seen  on  the middle third  of  right leg.
Feet are red, smooth  and infiltrated.   Several bullae  on
toes.   On  left foot are two deep ulcers—one behind  heel,
size of silver dollar ; one under ball of foot, size  of a silver
quarter dollar.  These  give no pain.
   Sensation.—Sensation of face and trunk  about normal.
Diminished on arms and forearms and nearly absent on lit-
tle fingers and outer surface of ringfingers.  Gradually di-
minishes from knee downward, and complete analgesia on
inner and outer surfaces of feet.   Is  nervous all the time.
Eats and sleeps well, but is very restless on waking in the
morning.  Hand shakes a great deal when he writes.  Has. 
34
dull, aching pains occasionally  along distribution of left
ulnar nerve.   Hands very  tender, and  leaning on a walk-
ing-stick produces blebs.   Weight, 140 pounds.
  A 10 per cent, salve of ichthyol with 3 per cent, of  sal-
icylic acid applied to face and ulcers; ichthyol internally.
This  was  continued  with a few intermissions for  nine
months, with no visible improvement except again of fifteen
pounds in weight.   The eruption remained the same  and a
nasal catarrh gave much  trouble.
  On one occasion the patient, when made to remove a
bandage from foot which had  not  been  touched  for five
days, disclosed a long pin  sticking  through the skin, with
an ulcer the size of a dime  at its entrance and exit there-
from.   A green deposit from the metal of the pin stained
the bandage and soft tissues.    The  completeness of the
anaesthesia will be understood when it is stated that the pa-
tient did not suspect this cause,  and considered the sym-
pathetic inflammation  which gave  trouble in the  femoral
glands  as a new  manifestation  of the disease.    Conclu-
sive evidence from his former physician  as to a previous
attack of syphilis prompted  specific  treatment, which pa-
tient has been taking for  past two months,  with excellent
results  to the  nasal catarrh and certain  rheumatic  pains
which have caused much  discomfort.  The ulcers on the
feet are nearly healed.  This case is all the more interest-
ing for the opportunity offered for the study  of  two kin-
dred and baleful diseases, both active in the same  subject.
Bullae still continue to appear.
  Case 21.  Lepra Anaesthetic a.—White man, aged 24,
native  of New Orleans.   Formerly resided in Avoyelles
parish,  La., but has lived in this city, Fourth  District, for
past eighteen  months.  Occupation  farmer.   Applied for
treatment in my  service at Charity Hospital, March 4th,
1888.
  Family.—Parents  have been  dead about fifteen years.
Does  not know cause  of  death.  Had a sister who  had
" sore legs" when she died, but does  not know  name of
disease. 
35
   Previous History.—Until three years ago enjoyed good
 health, when  water blisters  came  on  hands  and toes.
 Blisters disappeared as these became inflamed.  Says his
 body has been pigmented since he was  eight years old.
 Has felt a numbness of hands about  two years, and says
 that the left hand and legs and feet never perspire.  First
 two fingers of either  hand have ulcerated, and bone  has
 been removed.  First  two toes of right foot have been
 amputated on  account of carious bone.   General health
 and appetite good.
   Condition on Examination.—Skin of face thickened and
 slightly tuberculated.  Eyes congested.   Nose  swollen at
 bridge  and slightly deflected to right of median line. Ears
 thickened.   Voice harsh.  No  discoloration of face,  but
 eyebrows are scanty.  On trunk, legs and arms  are spots
 of pigmentation varying in  size, the largest being on the
 small of the back.  This spot or plaque is eleven inches in di-
 ameter, oval in shape, and has a well defined, copper-colored
 border, level with the surface, and a centre of apigmented
 or pure white skin.   Where the plaques are absent minute
 centres of pigmentation are seen  about  the hair follicles
 (xerodermic condition).   The  first  two fingers  of both
 hands have lost their distal phalanges, but the nails, which
 still remain, are clubbed and bent inward.  Abraided sur-
 faces on the swollen  fingers show the constant eruption of
 bullae.  Fingers  are very stiff, but  can be flexed.  Right
 hand moist;  left  hand very dry.  First two  toes  of right
 foot absent;  third now presents ulceration and  carious
 bone.  Toes of left foot swollen, but not ulcerated.  Urine,
 acid ; specific gravity, 1015.
  Sensation.—Normal on face  and trunk ;  diminished on
 forearms;  absent on backs of fingers and  toes.
  Treatment.—Chaulmoogra oil in increasing doses.  For
 first six weeks blebs continued to  appear on hands and feet;
bmt at the end of four months these had  ceased to form,
 the ulcers had healed, sensation had  improved and both
 hands had begun to perspire naturally. He was then tak-
ing twenty-five drops at a dose. 
   Case 22.   Lepra  Tuberculo-An^estiietica.—White
boy, aged sixteen years, native of New Orleans, resident
of  the  Second District.  Applied for treatment  in  my
service at Charity Hospital June 15th, 1888.
   Family.—Father born in Germany, mother in Ireland.
Father died of dysentery, fifteen  years ago.  Mother is
healthy.   Has one  sister,  who  is  healthy; three half-
brothers and one half-sister—mother's children by former
marriage—all healthy.  Never knew or saw any one with
similar disease.  Eats fresh fish constantly, particularly on
Fridays.  Does not care  for  salt meat.  Does not  go  to
school.   Cannot tolerate bright light.  Perspires freely at
slightest exertion.
   Condition on Examination.—Face pale and waxy. Skin
thickened.  Eyebrows  and eyelashes nearly gone.   Eye-
lids heavy. Conjunctivae yellow.  Flat, bluish-red tubercles
abundant on cheeks and chin.  Nervous expression about
the eyes.  Lips large, ears thickened and tuberculated.*
Bridge of nose depressed.    Deposit of tubercles on alae.
Neck normal.  Trunk emaciated  and  slightly discolored
with coppery patches, more particularly  about pectoral
region.
   Upper Extremities.—Elbows sore, with  a tendency to
ulcerate.  Arms and forearms discolored with yellowish pig-
ment.  Fingers smooth, dark and swollen.   They are stiff
and not easily extended on account of cicatrices from bullae
on their palmar surfaces.   Thumb and forefinger of right
hand have lost first phalanx, and nails are distorted.  Small
ulcer on left forefinger.  Pigment on thigh of a coppery
color.  On  knees  are circumscribed bluish-red, smooth
deposits, cicatrices of former ulceration.  Feet normal  on
back, but bluish-red on soles.  Toes red, shiny and thick-
ened.  A few blebs on toes.
   Sensation.—Normal about  face and  neck; diminished
on  arms.   Normal  on trunk.   Greatly  diminished  on
back  of hands.  Entirely  absent on fingers  and palms,
 *See illustration. 
- 'A -.'
Case 22.—LEPRA TUBERCULOSA. 
 
37
 where a pin can be stuck through entire integument  with-
 out  being  felt.   A heavy pin-scratch can be  felt any-
where on thighs and legs, but light  touches are not per-
 ceived.  Complete analgesia over entire surface both feet.
   The following three cases, patients of Dr. Bemiss, I had
 an opportunity  to examine at their residence, whither  I
 had accompanied him on  the  occasion of the serious ill-
 ness of the younger daughter (Case  25), who was then suf-
 fering from a high fever and great prostration.
   Case  23.   Lepra  Tuberculosa.—White woman,  aet.
 45 ; born in New Orleans.  Husband was born in Germany.
 Husband dead;  had liver disease  and dysentery (perhaps
 hepatic  abscess);  was  a  hard drinker.   Occupation la-
 borer.   No  signs  of  leprosy.   Patient married twenty
 years;  widow eight years.   Some  two years  after death
 of husband first noticed signs of this disease.   First came
 as a spot on cheek with tingling.   Has  two daughters with
 same disease.  Appeared about same time in them.  Eldest
 girl was then fourteen and the youngest eleven years of
 age.   Never  has  seen any one with  this trouble;  never
 heard of it.   Hypertrophy of skin of cheeks and forehead.
 No eyebrows : no tubercles.   Small scars on dorsum of
 feet.   This case was carefully noted and a history  taken
 some three years ago (1885), but  unfortunately the notes
 were lost.  It was marked  in the symptoms of leprosy then
 much more than at present.   But  it must be remembered
 that she has  been taking chaulmoogra  oil with only short
 intervals during all this time;  and has at times, though not
 regularly, been  using it externally,  especially  upon face
 and hands.
   Case  24.   Lepra Tuberculosa.—White girl, aet.  17;
 born in New  Orleans.  Daughter of case 23.   Has  never
 been  out of  city. This case presented  marked  symp-
 toms of  the  disease when she first  showed herself three
 years ago, but the notes were lost.   Now she simply shows
 some thickening of the skin of forehead, cheeks and ears,
.with partial  loss of eyebrows.   (There were none when 
:)*
first seen).  Hands  appear glistening red, especially to-
wards tips of fingers.  Cannot determine any anaesthesia,
though it was complained of when first seen.   There are
no  tubercles, nor any  remains  of any.   She has  taken
chaulmoogra oil constantly for three years.
  Case 25.   Lepra Tuberculosa.—White girl, aged  15
years.   Born in New  Orleans.  Daughter  of case  23.
Never out of city.   Her history, taken at the same time as
those of her mother and sister, was  also lost.  Now  she
shows the same thickening of skin of  face and ears, with
discolored hands.  On  right cheek is a large oval,  white
spot, surrounded by an area of bluish-red discoloration.
She has  no  eyebrows.  There  is  now no  anaesthesia
apparent and no tubercles.  She  has the stolid, fixed ex-
pression of the disease.  She has taken  the oil for three
years, but not so regularly as her sister and mother, nor in
such doses as she ought.  It makes her sick, and she often
fights against  it.  She  is  a sufferer from  inflammatory
rheumatism, attacks of  which are frequently severe.
  Case 26.  Lepra Tuberculosa.—White boy, aged 11
years, native of  Louisiana.  Applied for treatment  in my
service  at the  Charity Hospital, November  9th,  1886.
Resides in Third District, near the slaughterhouse. Parents
healthy.  No family disease.  Parents have eight  other
children—all healthy.  Some five years ago all took the
measles, and a short time afterwards patient noticed  swell-
ing of  hands and  lower extremities, followed by gradual
pigmentation of body.   General  health good.  Gets out
of breath when he runs.
  Condition on Examination.—Face very dark.  Skin of
entire face  thickened.   On forehead  skin  is wrinkled
vertically near median line, giving a  frowning expression.
Flat, red tubercles of various sizes on cheeks  and chin.
Hair dry  and of a brown color, being  lighter near the
edge of the scalp.  Ears  thickened but not deformed.
Eyebrows scanty.  Throat normal.  Tongue coated.  The
trunk is somewhat emaciated, and spotted  here  and  there 
 
Case 27.—LEPRA MACULOSA. 
39
with flat, brown patches of simple pigmentation, more or
less round, and averaging two inches in diameter.   In the
gluteal  region,  left side,  is  a white  patch the  size of
a silver dollar.   Raised erythematous patches and papules
abound on dorsal surface, lower  third of right arm  and
about elbows, also lower third of forearm on both surfaces.
On outer border of left forearm is a white patch of skin,
two  inches in diameter.  Genital organs normal.  A large
pigmented spot discolors  the  anterior surface  of right
thigh, and others  cover entirely the lower halves  of the
legs.   Tubercles the size of  a butterbean  are scattered
here and  there  over lower extremities.  These tubercles
have  a higher  temperature  (surface thermometer)  than
surrounding skin.   About the edges of the patches  on the
legs are  a  few  minute white  pustules.   Just above the
knee on the right thigh  is a  pale  patch, surrounded by a
well-defined dark border, all level with  the normal skin.
   Sensation.—About normal everywhere,  except on white
patches, which  are  completely anaesthetic.
   Chaulmoogra  oil,  gradually  increased to  twenty-five
drops at a dose caused the disappearance  of the red tuber-
cles, the  pustules  and much  of  the thickening of face.
To-day the boy is stouter, and, with the  exception of the
discoloration of the  body (less than  formerly) and the
aged  look of the  face,  he seems perfectly well.  The
anaesthesia has not changed.
   Case 27.   Lepra Maculosa.—White   girl,  aged   14
years.   Presented herself  in  my clinic   at  the  Charity
Hospital,  February  28th, 1888, with the following histo-
ry:  Born in the  Fifth District of this city (Algiers) and
has always lived there,  attending one of the public schools.
   Family History.—Father healthy; mother is subject to
malarial fever.  Is accompanied by a  grown sister, who
shows  no symptoms  of disease.  Has  had two other sis-
ters  and two brothers, all of whom died under the age
of six years, two of them dying of scarlet fever, and the
other two  died while teething, after a short illness. 
40
   The girl is a stout brunette, large for  her age.   Gives
 a history of malarial fever when nearly ten years old—fever
 without chills.   Never had marked diarrhoea.  During the
 winter preceding the attack of malarial fever patient had
 an ulcer on the sole of right foot the  size of a silver dol-
 lar.   This was a very ugly sore, and was  peculiar  inf that
 it "gave no pain even when washed and  rubbed."  Her
 sister volunteers the information that just about  this time
the  patient was  often  unnaturally  drowsy,  and   slept
 a great deal, and that she was easily startled  by a sudden
 noise or touch.  After the fever there came copper-colored
 patches on back of  neck, shoulders, thighs, legs  and feet.
 (Ulcer of foot had  healed under  perfect rest and  a mild
 ointment).  The eruption then appeared on  anterior sur-
 face of neck, and finally, a year ago,  there was  noticed a
 round, red spot on  the forehead.   Has had a swollen thy-
 roid gland.  Patient has never noticed increase or diminu-
 tion of sensation beyond the points already mentioned.
   Condition on Examination.—Face swollen  and covered
 with patches of  a bright bluish-red color.   These are dis-
 tributed over the centre  of  forehead,  cheeks, nose,  chin
 and superciliary ridges.  The  temples are normal, and
 there are patches of healthy skin beneath the rami of the
 lower jaw.  The ears are unaffected, but the holes for ear-
 rings are hard and always irritated when these are inserted.
 Throat erythematous, but  shows no deposit.  Eyebrows
 are scanty.   The trunk is  covered with more or less well-
 defined plaques of  an oval or irregular shape, yellowish-
 brown in color, and paler in the centre than at the periph-
ery.  These plaques are more numerous on the  posterior
 than anterior surface, and are well  shown in the accompa-
 nying lithograph, where their annular configuration maybe
 seen in a patch between the  shoulders about the size of the
 palm of the hand.  The skin between the diseased spots is
 white and smooth.   The skin of  the upper extremities is
.rather mottled, and the hands are swollen a little, having red,
 shining fingers, the  last two  on the right hand being perma- 
41
nently flexed.   There are two marks of successful vacci-
nation on the right arm.  The lower extremities are  cov-
•ered with brownish, ill-defined pigmentation, resembling,
below the knees, a mild form of ichthyosis.   Feet are red,
but not deformed.
   Sensation.—Normal on the face, but greatly diminished
to  the  point  of  analgesia on  inner surface of right arm,
ulnar side of both forearms and hands, particularly on the
two flexed fingers  of the right hand.   Feels but  does not
complain of pain  when pricked with a pin  on  the knees,
legs and left foot.   Anaesthesia complete on inner surface
of right foot.
   Being questioned, at a later visit, as to her diet, she de-
clared that at the time the disease began  she had eaten a
great deal of salt meat, and was very fond  of it still.
   Treatment.—Chaulmoogra  oil   ordered   in  increasing
doses, beginning with ten drops twice  daily.  In addition
to this she  was  ordered to cover her face  with  salve of
ichthyol, 5vi;  acid salicylic, 5ss; vaseline, q. s. ad §ii. M.
Naturally this application irritated the face, and has  been
discontinued  occasionally.  The   patient  has  been  seen
from time to time up to date  of writing, and shows  more
improvement  in  sensation than in  the  visible  lesions.
These latter are  only less marked and less  clearly defined,
but the depth of color remains. She has been  ordered to
stop school  and to  sleep  alone in  her bed.  The oil has
disagreed so often that  she has not been able to take  more
than twenty-drop doses.  A chemical  and  microscopical
examination of the urine revealed nothing abnormal.
   Case 28.  Lepra Tuberculosa.—White boy, aged 16
years ;  native of St. Martinsville, La.   Admittted into my
ward at the Charity Hospital,  May 8, 1887.  Has been in
New Orleans for eleven months, treated at Hotel Dieu.
  Family.—Father was a native of Louisiana,  and died of
leprosy in 1883,  aged 61 years.  Father's  mother came to
this  State from Martinique in  1801, at age of 7 years.  She
rwas accompanied by her mother, who  was supposed to 
42
have the disease.  Father of patient married three times*
No children by first wife; six (or more) children by sec-
ond  wife, and  four  children  by third wife, patient being,
one of the latter.  Testimony with regard  to children by
father's second marriage  is conflicting ; several of them,
however, are undoubtedly free from the disease.  Mother
was  a  relative of and  descended  from the person who
came from Martinique and was supposed to have leprosy.
So patient is liable to  disease from both parents.  Has  two
sisters who are  said  to  be  healthy.  I  have seen  his
brother and found on  him  no signs of this disease.  Patient
has two  female relatives  in St. Martinsville (his  father's
brother's children) who have undoubted leprosy.
  Habits.— Does not smoke or chew.    Has been  in habit
of eating fish, particularly  on Fridays.   Disease began
about ten years ago.  Most marked in  thickening of skin
of face and swelling of hands.   Has seen subject  to chills
and fever.
   Condition on Examination.—Patient rather stout. Gen-
eral  health good.  Skin  of face thickened everywhere,
particularly in region  of eyebrows,  which have fallen  out-
No circumscribed tubercles.   Leonine, fierce  expression.
Lips and lobes of ears thickened.  Lashes of  lower  lids
have  fallen out.  Hairy scalp  natural.  Entire face and
neck slightly reddened from presence of dilated blood  ves-
sels.  Tubercular deposit upon uvula  and both  tonsils. On
soft palate, just above uvula, is a deposit of brown pigment
size of a silver quarter dollar.  Trunk  covered here  and
there with yellowish-red pigment, level with surface.   Up-
per extremities normal, with exception of hands, which are
congested and swollen,  On the legs the skin is dry, harsh
and scaly, as in xeroderma.   On middle third of left leg
is a scar of  a  healed  ulcer, pinkish  in  centre and  sur-
rounded by brown pigment.   Both  feet have a dry, scaly,
unhealthy look.
   Sensation.—Good  everywhere, except in a patch  two-
inches long on ulnar side lower third of  right forearm 
43
where it is greatly diminished, and  on edge of cicatrix on
leg, where it is likewise diminished. Urine examined from
time to time and always found to be normal.
   In addition to drachm doses of chaulmoogra oil patient
was treated externally with  a salve of equal  parts of ich-
thyol and vaseline, applied  to  the  face.   The salve was
continued, with a few intermissions  of two or three weeks,
for nearly a year, and produced no better result at the end
than discoloration of the skin.  The oil has been stopped
from time to time and  the dose diminished on account of
intolerance.  An occasional fever, lasting a few days, and
an ulcer on seat of  old  cicatrix (now healing), have been
the only accidents.
   Case  29.  Lepra Tuberculosa.—White boy, aged 15
years, native of New Orleans.   Resident  of  Second Dis-
trict.   Applied  for treatment in my service  at Charity Hos-
pital, December 1st, 1886.  No history of disease in family.
Accompanied by parents, who  are  healthy.  Two sisters
and three  brothers, all healthy, with  exception  of one
brother, who has the same disease.   Disease began about
five years ago  as pigmentation  of  the legs, followed  by
tubercles on  face.  Mother states that there was  a negro
man living on  premises who had  an eruption on body.
Does not know what has become  of him.   Patient is very
lean, and dark complexioned.  Appearance is remarkable.
Mouth  large, ears  prominent and  bent forward.  Face
covered  with red tubercular nodes, most  marked about
cheeks.  Ears  much  thickened.  Eyebrows  and  lashes
gone.  Frightened  expression of face.  Deposit on soft
palate.   Voice  very harsh.  Pigmentary deposit all over
body.   Small tubercles on forearms.   Fingers swollen and
stiff.   General  health poor—has fever.  Chaulmoogra  oil
seemed  to act as  a tonic and  improve locomotion,  but
patient was very weak when last seen
   Case  30.  Lepra Tuberculosa.—White boy, aged 13;
native  of New Orleans.  Resident of Second District.
Brother to case 29.  Applied for treatment  December 1st, 
44
1886, at same time as brother.   Sick two  years—disease
beginning  as  eruption  of  nodes  on  face.   Thinks he
caught it from brother,  as he always slept with him.   Has
same physiognomy as brother, only his features are more
exaggerated.  Ears more twisted, and the lower  eyelids,
instead of gently curving towards  the outer canthus, form
an obtuse angle a third of an inch from it, greatly broaden-
ing the angle of  the canthus.  These defects are congen-
ital.  Skin  of   face  thick and pigmented.   Upper lip
swollen, and left side of nose  covered with tubercular de-
posit.  Eyebrows very scanty.   Eyelids waxy and heavy.
Small tubercle on soft palate, near uvula.  Voice  hoarse.
Tubercles on back of ears.  Trunk and  extremities  lean
and covered with mottled  pigment.   Sensation  normal.
Chaulmoogra oil.

  Case 31.   Lepra Tuberculosa.—White man, aged 51
years.   Native  of  Manchester,  England.   Applied for
treatment in my service at  Charity  Hospital, November
26th, 1887.  1° Louisiana thirty-one years, excepting three
years of  service in the  Confederate army.  Had typhoid
fever in 1850; yellow fever in  1858, and  chills and  fever
off  and on—the last time ten months ago.  Had  syphilis
twenty-five   years ago,  and was treated  by  Dr.  H.  D.
Schmidt.  In New Orleans up  to  1872, when he  went to
St.  Martinsville, where  he  remained from  April till Sep-
tember, keeping a dry  goods store  while  there.   Never
saw any cases of leprosy while  there.   Had dysentery
when in St.  Martinsville, but had  had it before.   Was a
nurse in this hospital in  1883, remaining twelve months in
institution.   Returned in July, 1886, with malarial fever,
and left again in December of same year in order  to ped-
dle   dry  goods in the  country.  Visited  parishes of St.
Charles,  St. John and  Jefferson.   Reentered hospital in
May, 1887, nursing in ward 31 (for negro men), and has
not  been out of institution since then.  A mulatto  man
from St. Martinsville, who  had leprosy, was an inmate of
this  ward,  but  patient  says that he never gave  him his 
45
 medicine, the mulatto always keeping his own medicine
 separate from the rest.  Patient has eaten with this  man
 fruit cake made  by the leper's mother, who is regarded as
 a suspicious case.   Patient's finger has been  sore and ten-
 der since  coming to hospital.  Thinks this is due to  con-
 stant irritation from medicines.  Patient cut himself while
 shaving six weeks ago, and eight days afterwards noticed
 erythema  of  skin'where  he had  cut himself.   Keeps  his
 razor and soap concealed from patients, and no one allowed
 to use them  but himself.
  Family.—Parents were healthy when last seen;  his sis-
 ters and brothers, ten in number, showed no  evidences  of
 skin disease when last seen.  No family disease.
   Condition  on  Examination.—A few typical syphilitic
 scars on trunk and extremities.   Under left eyebrow  and
 on right side  of  jaw  are two  raised erythematous spots,
 larger than a silver dollar and of irregular shape.   Scattered
 over face are a number of smaller macules of  a bright red
 color.   Right ear reddened and thickened at  the lobe.   It
 is  also  painful.  Throat  slightly  erythematous.  Over
 posterior  thoracic region  are two  oval,  scaly, copper-
 colored patches,  situated one on either scapula.   Their
 long diameters are two  and a half inches, and they are
 level with  the surface.  They are  pale in the centre  and
 have the appearance of rings.  On either gluteal prominence
 is a  patch like those just mentioned:  one has a pale centre,
 the other  is decidedly ringed.  On right knee and just be-
 low  are ill-defined, reddish  patches, level with surface and
 quite anaesthetic unless severely pricked with a pin. Several
 irregular red patches  of  small size are noted  elsewhere.
 One is just on the edge of an old syphilitic scar, but does
 not encroach upon it.  The spots  on face  and trunk are
 not anaesthetic.   On left foot is an irregular patch, red and
flat  and  size of palm  of  hand.  This  is completely
anaesthetic.  Small  patches of anaesthesia are also found
on  both knees and in middle  third of left leg.   Urine
normal.   Patient kept under observation until December 
4G
 io, 1887, and as the  symptoms multiplied  the  following
 was ordered for face :  Resorcin, gr. 25 ;  ichthyol, gr, 25 ;
 salicylic acid, gr. 50; vaseline, enough to make an ounce.
 Chaulmoogra  oil was  given internally until he  took fifty
 drops  at  a  dose.  The  improvement  was  rapid  and
 altogether satisfactory, and in six months after its institu-
 tion nothing visible remained of the disease but two patches
 on the nates (treated with pyrogallol and flexible collodion),
 and a small amount of  anaesthesia on the knees.   The total
 anaesthesia of  the left  foot has disappeared.  The man is
 practically well and considers himself cured; but lest the
 disease should  reappear at  any time he is instructed  to
 continue the oil as long as he is able to take it.   Here let
 me say that although all the symptoms which led to the
 diagnosis of this case have disappeared I deem it not only
 rash, but unscientific,  to pronounce  upon the cure  of a
 case of lepra within less than  ten or fifteen years after the
 disappearance of symptoms.
  Case 32.  Lepra Aislesthetica.—Negro man, aged 28
 years,  native of  St. Martinsville, Louisiana.   Occupation
laborer.  Admitted into  my  service at Charity  Hospital,
June 28th, 1887, while in articulo mortis.   History of hav-
 ing been ill for eight1 years.   Was born blind.   Has lived
in the city (Second District) for some time.   Died within
 a few hours of admission.
   Condition on  Admission.—Emaciated to  an  extraordi-
 nary degree.  Ulcers of various shapes cover hands, arms,
 thighs, legs and feet.  Toes  falling off with ulcerations.
 Fingers  are all imperfect,  having   been destroyed  from
former ulceration.
  Sensation.—Diminished in places  on the  face; entirely
 absent on lower extremities.
  Friends claimed the  body,  and only a section of skin
 from edge of an ulcer on thigh could  be  removed.   This
 was examined and found to  be  crowded with the bacillus
 leprae. 
47
   Case 33.  Lepra Tuberculosa.—White man, aged 54,
native of Bremen.  Resident of Third District.  Admitted
into my ward at the Charity Hospital, March 7th, 1887.
Has been prescribed for at this hospital a number of times
during the past seven years.  Occupation iron-moulder.
Been in New Orleans for twenty-one years, coming directly
from Bremen, and has never been out of city since,   Has
relatives, but knows nothing about them.   Father died of
apoplexy. Cause of mother's death unknown. Never knew
any one with disease.   Has had a venereal disease—prob-
ably chancroids.  When disease began was in the habit of
mating  salt  meat, but has  never  eaten much fish.  Had
chills and fever  occasionally,  beginning seven years ago,
but has not had  them for past two years.   Disease began
with the attacks  of chills and fever, accompanied by tuber-
cular thickening of the skin of face.
   Condition  on Examination.—Very  much emaciated.
Skin of face pigmented to a dark color, and greatly thick-
ened about superciliary  ridge, with long vertical  corruga-
tions between,  in median  hue.  Nose  flattened, particu-
larly at bridge, from either  side of which  extends  down-
ward a band of red, thickened skin, curving around angles of
mouth  and  nearly corresponding in situation  with  the
elevator muscle  of upper lip.   Ears   enlarged and  thick-
ened, the lobes being pendant in large tuberculated tumors.
Eyebrows and lashes gone.   Conjunctivae yellow.  Uvula
ulcerated away and scars on soft palate.  Voice extreme-
ly hoarse and almost undistinguishable.  Trunk and limbs
pigmented almost everwhere, but patches are not well de-
fined.   Scattered over  trunk,  especially  on anterior as-
pect and also on arms, are small red tubercles.  On fore-
arms there are tubercles also, but these are well raised, of
purplish color and bleed easily when  pricked with a  pin.
They are more numerous on the dorsal surfaces.   Skin of
thighs, legs and  feet  has a dry and  drawn look.  There
is  redness and infiltration on left thigh,  just above knees,
and the great toe is  ulcerated.  Knee  joints swollen and 
48
painful,  and  contain  serous  effusion.    Appetite  poor;-
bowels constipated.  Patient in a condition  of apathy, as
if he did not care what became of him.   Sight  not very
good.  Pupils contracted.
  Sensation.—Diminishes  downward  from elbows  and:
knees, becoming entirely absent on hands  and feet.
  Ulcers which appeared from time to time have healed
under iodoform  salve.  Attacks  of articular  rheumatism
have been quite frequent, and are always  ameliorated  by
iodide  of potash  and wine  of colchicum.  Urine  con-
tained granular and hyaline casts about  a year  ago, but
has been normal for some months.  Cannot tolerate chaul-
moogra oil.
  Case 34.   Lepra Tuberculosa.—White girl,  aged 18;
years, native of New Orleans;  resident of Third District.
Applied for treatment in my service at Charity  Hospital,.
August 15th,  1888.   Resided  in  New Orleans  until five
years ago, when she moved with her family to New Iberia,
La.  Took up her residence in this city again six  weeks-
ago, residing in the Third District.
  Family.—Father born  in  Germany, but has been in
Louisiana for many years.  Mother was a  native  of New
Orleans—died in child-bed. Father has married again, and
stepmother  accompanies  patient to hospital.   Patient's
stepmother has had eight  children—five   are  dead,  and
three are living.  The former died of heart disease, small-
pox, and infantile debility.   Stepmother and three living
children are perfectly healthy.    Patient's paternal  uncle
and grandmother are alive  and in good health.
  History.—Eats fish and salt meat sometimes.  Formerly
attended school.   Felt perfectly well when  she left New
Orleans five years ago, and did not have  any  trouble for
some months afterwards.  Sickness began as a swelling of
legs about four years ago, and was supposed by  relatives
to be approaching puberty.  It was then  noticed that  the
face would flush when the slighest  exercise  was  taken.. 
49
 Had chills and fever occasionally  while in  New Iberia.
 Pigmentation and thickening of skin came on, but menses
 never appeared.
   Condition  on  Examination.—Height, four feet  two
 inches.   Weight,  eighty-five  pounds.    Body  emaciated
 and of dark complexion.  Patient's disposition is morose,
 and her intellect is evidently  stunted.    Though eighteen
 years old her development is that of a child.   Mammary
 glands are as rudimentary as a boy's, with the  exception
 of a slight tumefaction at the  nipple.    No axillary nor
 pubic hair, and has never menstruated.    Two marks of a
 successful vaccination  on  arm,  said  to have been done
 when patient was six  months old.
   Face shows no tubercles, but is dark and of  a slightly
 reddish tint.   Nervous, frowning expression of face.  Eye-
 brows and lashes nearly entirely gone,  particularly lashes
 of lower lids.  Bridge of nose  thickened; ears normal;
 trunk and upper extremities slightly pigmented.  Fingers,
 feet and toes swollen.  Scars  on elbows.  • Legs  smooth
 and scaly below the knees.   Toes of right foot  sore  from
. friction of shoes.  Smooth,  soft, tissue-paper-like scars on
 knees similar to those on elbow, and are the remains of an
 earlier ulceration.
   Sensation.—Occasionally has a numb feeling in fore-
 arms and legs.   Sensation tested with a pin  and found to
 be normal.
   Case 35.   Lepra Tuberculosa.—Mulatto man,  aged
 21  years; native of St.  Martinsville, La.  Admitted into
 my service  as an inmate of  the Charity Hospital in the
 summer  of  1887.
   Family.—Paternal grandfather was a white man.  Father
 and mother are mulattoes; both parents living.   Mother ex-
amined in May, 1888, when the Louisiana Board of Health
 investigated  this disease in St. Martinsville and pronounced
 it a "suspicious case."   I saw her at the time  and noted
 that she was covered with a number of slightly raised
J 76$ 93 y 
50
 ringed patches and had a spot of anaesthesia on one of the-
 lower  extremities.   Examined more recently  the rings
 were noted to have entirely disappeared, but the anaesthe-
 sia remains.  She is known to have communicated  fre-
 quently with a leprous family.  Patient  is the only child
 by this marriage, but the  mother has lived  with another
 man for  over fifteen years, and has had by him  a number
 of healthy children, including a stout and hardy baby two
 years old.  Disease began on the son some months ago as
 nodes upon the face, with considerable thickening.
   Condition on Examination.—Tall mulatto, of good phy-
 sique.  Tubercular nodes on face everywhere,  including
 ears.   Eyebrows scanty.  Eyelids thick and lashes nearly
 gone.  Throat red; voice husky.   Trunk normal.  Hands
 and feet swollen and  skin  thickened, but not  pigmented.
 Small ulcer on left forearm. Genital  organs normal. Gen-
 eral health and appetite  good.
  Patient was given  pills of ichthyol (gr. ^i. each),  and
 ointments of ichthyol and salicylic acid were rubbed on the
 face twice a day.  The immediate effect was to smooth
 the face  and produce general  amelioration of  symptoms
 for about three months, when the tubercles began to re-
 appear during the treatment,  though ichthyol was used lo-
 cally as strong as he could bear it.   This plan of  treatment
was  continued nine  months with few intermissions, when
 chaulmoogra oil was resorted to.  Patient in the meantime
was frequently given  cinchonidia for  chills and fever, the
 medicine always breaking the chills.  After fifteen months'
residence  in the  Hospital  the  patient left it, in many re-
spects  much  improved;  when  he   was taken with an
acute disease, producing dropsy, and  died after  a weeks'
illness.  The immediate cause  of his death could  not be
ascertained.  This  patient was an  inmate  of  the ward
where  case 32 was a nurse.
  Case 36.  Lepra Tuberculosa.—Patient  referred to
me by Dr. Bemiss in May, 1888, but the doctor's notes,. 
51
 taken five years  ago, being quite complete, I  shall give
 them nearly in full.   The symptoms  when  noted by me
 were  much  more marked than those here  recorded, the
 disease  being  more  advanced.    White man, aged  21
 years (1883);  native of New  Orleans.  Parents born in
 Ireland and there married.  They moved to  New Orleans
 in 1852, and patient was born in 1862.   Father living and
 healthy.  Mother died  of a fever in  1878.   Has three
 healthy sisters living.  Two of them are married and have
 healthy children.  Patient has never been away from city
 but once;  then to Memphis, in May, 1882,  returning be-
 fore the end of  the month.   Only other relative in the
 United States is an aunt, who lives near Charity Hospital.
 She is well and has healthy children.
   Occupation.—Sack-sewer  at oil works in  Algiers.  No
 one  in works  had this  trouble.  A queer-looking passen-
 ger was  accustomed to travel daily on  the ferry with him
 before he was afflicted, who  had  swollen features  very
 much like those which patient  now has.
  Personal Habits.—Temperate as a rule.  Uses tobacco;
 chews.  Was  not very  loose in  his  habits.   Once had
 gonorrhoea for two months.  Never had syphilis.  Accus-
 tomed to spending much time in Royal  street saloons and
 in back part of town.  Eats fish on Fridays, on other days
 beef and vegetables;  of the latter chiefly potatoes and cab-
 bage, but not much, if any, rice.   Occasionally eats ham.
  Previous Disease.—Chills  and fever  in 1879 and 1880,
 being treated by a physician both times.
  History  of  Disease.—First  thing patient  noticed was
 about ten copper-colored spots in vicinity of navel.  Three
 months afterwards spots  began to appear on left arm, near
wrist,  and then  on right  arm, as  diffused reddish flush.
Something like a month later very fine desquamation of the
 cuticle of face and ears took place.   Companions accused
him at this time of powdering his face.  Spots on abdomen
appeared about April, 1882, as  near as he can remember. 
52
In September, 1882, face and ears, in the course of two or
three days, became red,  simulating  sunburn.   Three or
four weeks later face began to swell and become lumpy.
Hands became blue (i. e.,  capillary congestion)  about Jan-
uary, 1883.   In about October, 1882, first noticed blebs on
upper radial side of forearm.  They  appeared  very sud-
denly, were oval  in  shape and about one-half  inch  long.
They were  not  at all painful, and were very  sluggish in
healing.
  Present Condition.—Height,  five  feet  eight  inches.
Weight,  145 pounds.  Stout,  muscular man.    Hair and
beard  black; eyes brown;  skin  characteristic  copper
tint.  Skin  of whole face hypertrophied  and  infiltrated,
especially that of  brow, nose,  malar region, lips, chin and
ears.  Discoloration and  thickening  gradually  fades  to-
wards neck.  On left side of neck  is a reddish, oval spot,
size of a silver quarter-dollar.  Arms to elbows  quite  na-
tural, with exception of being  covered with numerous light
brown spots from size of a pea to that of a hand.  These
are quite regularly distributed from apex  of one shoulder
to middle of sternum, and then to apex of other shoulder.
No spots posteriorly.  Right forearm and hand  have  dark,
bluish spots.  On fingers of both hands and ulnar  side of
right wrist are a few blebs and a number of scars where
blebs have been.
  Sensation.—Greatly diminished in hands and feet.   On
ulnar side of forearms two points cannot be distinguished
closer than six and one-half inches.   Sensation is dimin-
ished to about the  same  extent as this on both legs, and
is complete on the great toes, varying in degree here and
there upon the feet.
  Case 37.   Lepra Tuberculosa.—White boy, aged 17 :
native  of  New  Orleans.  Occupation,  newsboy.  Resi-
dent of Third District.  Applied for treatment in my ser-
vice at Charity Hospital, August 20th, 1888, accompanied
by  his mother. 
'.)■)
  Family.—Father born in Germany and has been living
thirty-one  years in New Orleans.  Mother born in Alsace
and has been in New Orleans  for thirty-five years.  Both
healthy and never heard of a similar  disease  in  family.
Mother has four other  children—two boys and two girls__
all healthy.   One boy is 14 and the  other 23  years  old
Lost two children, the  causes of death being scarlet fever
and dentition.
  History.—Has had chills and fever off and on for three
years.  Had them also  when much younger.   Delicate as
a child.   Boy formerly worked in a brush factory in Third
District.  Has been withdrawn.  Never had  dysentery.
Seldom eats fresh fish,  but eats salt meat about  once a
week.
   Condition on Examination.—Boy tall and  thin  and of
dark  complexion.   Is just arriving at puberty.   Noticed
one year ago a few irregular blothes on the cheek  resemb-
a bruise, and which appeared  afterwards  on  chin.  Face
slightly swollen, but features  not  deformed.   Nose, ears
and lips normal.   Eyebrows thick, lashes long and curled.
Skin  of face of a bluish-red color, here  and there  in ir-
regular  blotches.  Tongue  shows  enlarged  fungiform
papillae.  Follicular pharyngitis.  Trunk is lean, and skin
very  slightly darkened here and there.  Bluish-red, ill-
defined patches on  nates.  Genitals normal;  also thighs.
On lower half of rear of both legs is a red, clear-cut, scaly
eruption,  diminishing in depth of color toward  anterior
surface, where it takes on a xerodermic appearance.   Fin-
gers slightly swollen and pigmented.
   Sensation.—Anaesthesia not complete  anywhere,  but
sensation greatly diminished on legs and feet.
   Treatment.—Gurjun oil to  be increased five   drops  a
week.
   Case 38.   Lepra Maculosa.—White woman, native of
New  Orleans, aged 36 years.  Unmarried.   Applied for
treatment in my service  at  Charity Hospital, September
29th,  1888. 
54
  Family.—Father born in France.   Is  dead; cause un-
known.  He had for some years an itching eruption called
eczema.   Mother born in Cuba; died of  cholera.  Father
married twice ; patient is by second marriage.  Father had
two children by  first marriage  and both are  dead—one
from consumption and one from pneumonia; also two other
children  by second marriage—one dead and one living.
Patient had eczema as a child.
  General Considerations.—Appetite good ;  bowels regu-
lar.   Teaches  school.   Lived at present  residence  in
Third District since childhood.  Eats fish  and salt  meat
occasionally.  Has been subject to pains in shoulders for
four years.  Disease  began about four months ago as a
rose-colored macule on left cheek;  it then  appeared  on
other parts of body.
  Condition on Examination.—Face is natural  in every
respect, with exception of an  oval, rose-colored spot just
to left of nose,  size of a silver dollar, and a  small spot
near left  eye three lines in diameter.   A few small patches
here and there on neck.  Trunk and right upper extremity
normal.  On upper part of  left forearm and elbow are red,
scaly  patches, with well-defined borders,  slightly raised.
On lower part of  left  forearm  and hand  is a single patch
of same  character, changing in the palm to an erythema-
tous patch.  Hands slightly swollen.   Nothing on  thighs
nor right leg.  Left leg covered with red, scaly patches
from two to five inches in diameter, and  having pale cen-
ters.  Feet are red, but show no special eruption.
  Sensation.—Diminished in all the  patches  except that
on the face.  No complete  anaesthesia anywhere, but con-
siderable analgesia on left  hand.
  Treatment.—Twenty-drop doses of chaulmoogra  oil  in
capsules.  Frictionings with same.
  Brief notes upon the three   cases following were fur-
nished me by Dr. A. M. Beret, assistant sanitary inspec-
tor, and were taken by him in 1887, anc* forwarded with a
report to the Board of Health : 
55
   Case 39.  Lepra An^esthetica.— White man, aged 30
years ; native of Italy.  Occupation, wagon-driver.  Family
consists of mother, two brothers and a sister, all of whom
are robust and healthy.  Has  never  heard of the  disease
occurring in his family.   Patient is  unmarried. Lives in
Third District in a healthy locality.  This is an exception-
ally severe case.  The man appears to be  rotting away,
being covered with ulcers, and is a terrible sight to look
at.  There are three persons  occupying  the same prem-
ises.
   Case 40.  Lepra Ax^esthetica.—Negro woman, aged
45 years ;  native of New Orleans.   Can  give no informa-
tion relative to family history.  Married and has two chil-
dren in good health.   Resides  in Second District.  Cis-
tern water and general condition of premises where she re-
sides are as they should be.
   Case 41.  Lepra An^sthetica.—White woman, aged
48 years ; native of France.   Occupation, grocery-keeper.
Says the disease is unknown in her family, and has  no idea
how it was contracted.  Is married and has three children,
all in excellent health.    Lives in a  healthy locality in the
Second District.  Seven persons live upon the same prem-
ises.
   Case 42.  Lepra An^esthetica.—Negro man, aged 19
years; native of New Orleans.  Carpenter by trade.  Both
parents living and in good health.  One sister died  of  le-
prosy about three years ago.  No history of disease  in fam-
ily, and does not know how the disease  was contracted.
Resides in Second District, in a  low, swampy locality.

   Having completed the  relation of cases,  in  which it is
feared the unavoidaole repetition of symptoms has proved
somewhat monotonous  to the reader,  it  may  be  well to
place certain salient points of each case before the eye for
rapid reference and comparison.  Accordingly the  follow-
ing table has been arranged and will  explain itself: 
56
	>• h		j		*	Nativity	0 Relatives	
	1 P		«		u	OF	■<	WITH
<	A 1 H 0 I <		0		X	Parents.	3	Leprosy.
u	< 60	i *	0	C/3	r>		Q	
I		Germ.	W.	F.	I A.	Germany.	1 year.	
2	16 N. O.		w.	M.	T.		2 years.	
3	35 Germ.		w.	F.	M.-A.	Germany.	5 years.	
4	29	N. O.	w.	M.	T.		3 years.	
5	25	Mo.	w.	F.	T.		7 years.	
6	26	N. O.	w.	F.	M.-T.	Ireland.	7 vears.	
						("Father in		
7	26	La.	B.	F.	T.	-j Italy, moth-(er in La.	3 years.	
8	75	La.	W.	F.	M.-T.		2 years.	
9	48	Germ.	W.	M.	M.-A.	Germany.	5 mos.	f Step-mother
IO	35	Germ.	w.	M.	T.-A.	Germany.	10 years ^ and two half	
n	47	La.	w.	F.	t.		6 years.	(brothers.
12	46	A'tria	w.	M.	M.-A.	Austria. jio years		
J3	27	N. O.	w.	M.	T.-A.	Ireland. 14 years		
M	35	N. O.	w.	M.	M.		18 mos.	
J5	65	Irel'd.	w.	M.	M.-A.	Ireland. f Father and		
16	10	N. O.	w.	M.	T.	< mothr's fath-er from Ger.	5 years.	
i7	63	Germ.	w.	M.	A.	Germany.	18 mos.	
18	27	N. O.	w.	M.	T.			Mother.
J9	57	Germ.	w.	F.	T.-A.	Germany.	8 years.	
20	27	N. O.	w.	M.	M.-A.	Ireland.	18 mos.	
21	24	N. O.	w.	M.	A.	f Father Ger-	3 years.	Uncertain.
22	16	N. O.	w.	M.	T.-A.	\ man, mother (.Irish.		
23	45	N. O.	w.	F.	T.		6 years.	Two daughters
24	17	N. O.	w.	F.	T.	Moth'rinN. O	over 4ys	Moth'r & sister
25	15	N. O.	w.	F.	T.	Moth'rinN.O	over 4 ys	Moth'r & sister
26	11	La.	w.	M.	T.		5 years.	
27	H	N. O.	w.	F.	M.		4 years.	f Father and
28	16	La.	w.	M.	T.	Louisiana.	10 years	•j several rela-tives.
29	15	N. O.	w.	M.	T.		5 years.	Brother.
30	13	N. O.	w.	M.	T.		2 years.	Brother.
31	5i	Eng.	w.	M.	T.	England.	5 weeks.	
32	28	La.	B.	M.	A.		8 years.	
33	54 iGerm.		w.	M.	T.	Germany. [Father in	7 years.	
34	18 N. O.		w.	F.	T.	\ Ger., moth'r (inN. O.	4 years.	f Mother is a
35	21	La.	B.	M.	T.	Louisiana.	over 1 yr	-1 s u s p icious-(case.
36	21	N. O.	w.	M.	T. 1	Ireland.	1 year.	
37	17	N. O.	w.	M.	T.	Germany. [Father in	1 year.	
38	36	N. O.	w.	F.	M.	< Fr'ce, moth-(.er in Cuba.	4 mos.	
39	3°	£al£	vv.	M.	A.		years.	
40	45	N. O.	B.	F.	A.			
41	48	Fra'ce	w.	F.	A.			
42	*9	N. O.	B.	M.	A.		ISister.	
 
ot
  Age of Cases.—We see from the tabulated statement that
there were no  cases under  10  years of age.  There  were
thirteen between 10  and 20;  eleven  between 20 and 30;
five between 30 and 40; six between 40 and 50;  three be-
tween 50 and 60;  three between 60  and 70;  and one be-
tween 70 and 80.   Though none were seen younger than
10 years, three of these cases developed the disease before
that age; and though all ages  are  represented, more than
halt of the cases were between 10 and 30 years.  The old-
est patient was 75 years old, and is s;ill alive.
  JSativity.—Of  the  forty-two cases  twenty-nine  were
natives of Louisiana, including twenty-two natives of  New
Orleans.  Natives  of Germany, seven;  of other foreign
countries, five;  of other States, one.
   Color.—The majority  of the thirty-seven white persons
were of  dark complexion, and the  majority of the colored
persons were mulattoes.
   Sex.—The males were in the majority, being twenty-six
in number, while there were only sixteen females.
   Variety.—For the  sake of  systematic classification the
form of  the  disease has  been given  in every case, but it
should be understood that  this simply indicates the  most
prominent symptoms; for nearly all of the anaesthetic forms
were accompanied by macules and tubercles, and the tuber-
cular forms by nerve lesions  and pigmentation.  Leprosy
which is purely tubercular,  macular,  or anaesthetic, is very
uncommon.
  Nativity of Parents.—It is a significant fact that in  Lou-
isiana, where a large proportion  of the  oldest inhabitants
are natives, we find that as  many as eighteen of the cases
here reported are children of  foreign-born parents, and as
many as twenty are  children of at least one  foreign-born
parent; from which we  conclude  that  if the disease is
hereditary  it must  be  derived from  a variety of foreign
sources; and if acquired then it seems to attack the  chil-
dren of immigrants  as often as those of the older native
families. 
58
   Duration.—The figures here recorded can give no idea
of the expectation of life in this disease,  for a large  ma-
jority of the patients are still living and may  live on for
many years.  But experience with these cases has already
shown that proper  medication and wholesome  diet  can
greatly ameliorate symptoms; and it cannot be  denied
that the greatest ravages of leprosy are upon  those who
are least able to resist them physically.   Three  cases  are
here reported in which the first symptoms  appeared  five
months, five weeks and  four months,  respectively, before
applying for treatment.   These are  brief periods, but as
leprosy has  no known initial lesion, like syphilis,  it  is im-
possible to say how long the patients were diseased before
the first symptoms attracted attention.    After  careful in-
quiry upon this point the author has come  to the conclu-
sion that in certain  cases the disease  has   lain  dormant
through an exceedingly long period  of incubation  before
the skin lesions made their appearance, and that the dura-
tion of this  period of latency in  leprosy is greatly modi-
fied by the diathesis or resisting power  of the  individual.
It is probable that a stout, healthy  man is  as little apt to
become leprous as he is to   become   tuberculous, unless
there be hereditary taint.
   Relatives Afflicted.—We find that there were ten patients
who  had other  relatives afflicted in  the  same manner;
while, on the other hand, these ten have lived and come in
constant contact with many other relatives and friends who
have not contracted  the  disease.   Some of the  patients
have had perfectly healthy children after the disease  be-
gan, but the rule  seems  to be in females for  pregnancy to
end in a miscarriage or in a weak, delicate child.
  Diet.—Questioned as to food the  majority of  patients
have shown that they live on a mixed  diet  of  the  usual
meats and vegetables that can be  procured  by the poor.
Salt meat and fish, when they can be procured, are  eaten
by the poor all over the world.  In the warm summers of
New Orleans it is probable that much of the meat and fish 
59
•eaten by the poorer classes is not as fresh  as it should be;
and it is said that the various viscera and stale products of
the butcher's stand, sold under the name of " cat and dog
meat," and fit only for such animals, are purchased by the
lower classes of New  Orleans and used  as articles of food
by them.  This  is  certainly a possible  source of disease.
   Lntercurrent Diseases.—The two maladies which have
complicated the cases here reported are  malaria  and syphi-
lis.   Nearly all  of the patients complain of having had
malaria, and on several occasions these attacks have been
observed.   Most of them were the ordinary leprous fevers,
coming irregularly  and easily broken with quinine, but re-
appearing while  the quinine was still being  taken.   But
not a  few of them  had regular intermittent  fever, which
was preceded usually by a chill  and followed always  by a
sweating stage.   This fever yielded to quinine.
   Case  20  is syphilitic.   His symptoms were  becoming
aggravated  until  iodide of potash was used, and then im-
provement was immediate, though the blebs of leprosy  con-
tinue to appear as usual.
   Case  31  has had syphilis, and, though not treated  with
anti-syphilitic remedies, improved to a wonderful extent on
large doses of chaulmoogra oil.  The syphilis was of  long
standing.
   Case  33 has probably had syphilis, though  the history is
not clear.   He is subject  to muscular and articular pains,
often with swelling of the joints, and iodide of  potash and
-colchicum give immediate relief.
   Etiology.—Tainted  animal food  as a possible cause of
this  disease has  already been alluded to;  another and
much more certain one is heredity.   But the cases  here
recorded, in which  a child inherits from a parent or ances-
tor, are so  very few  that we are forced to look for some
■other solution of  the question.  We find here a  large num-
ber of persons, not related to one another and having an
entirely different  ancestry, coming from a variety of coun-
tries.   It  is probable that  several of  these  persons may 
60
have developed in this State a malady which was inherited
or acquired from others in older countries.    But it is im-
probable that so large a number of  ancestors should have
been  tainted with a  disease which  is exceedingly rare in,
Germany, Ireland, France and Austria, and that their de-
scendants should have met at this time all in one particular
locality, which certainly presents no special inducements to
persons suffering from leprosy.
  Now, though possessing no absolutely reliable history  of.
direct  inoculation, there  are several cases  here  reported
which would lead one to suspect that the disease may have
been acquired by contact with another person afflicted in a
like manner.  Sometimes the evidence is weak, but let us
see what it amounts too.   It is well known that the Louis-
iana Board of Health has, on two different occasions, sent
its officers to examine and report upon cases of leprosy
said to be on the  banks of the lower Lafourche* and  in
the town of St. Martinsville.!   The investigations showed
that there were from  twelve to fourteen cases in the parish
of Lafourche, and only three  positive and  three  doubtful'
cases in St. Martinsville.
  Referring to our  histories we find that case 3   acquired
dysentery and first  noticed leprous  spots while   living  in.
Houma, a town situated but a few miles from the infected
district on  Bayou Lafourche.   Case 20, while  suffering
from a recent attack of syphilis, was in the habit of riding
up and down Bayou  Teche to St. Martinsville.   Case 36,
before taken with the disease, traveled daily on the ferry
with a passenger whose  deformed visage suggested that
here was  a  similar disease.  Indeed the physiognomy  of
leprosy is  a remarkable one,  easily recognized, and  we
have more than  once had our  attention attracted to the
Dromio-like manner with  which these cases eye one another
on  meeting accidentally  in the ward.  Cases 32 and 35
were colored men from St. Martinsville.  Little is known.
 *Keportof Board of Health for the year 1S80, p. 217.
 tResults reported May 2, 1887. 
61
about the  former, but his  dark  skin  showed  that  both
parents were  probably negroes, and it  is believed that he
worked for a family there afflicted with the disease.
   Case  31, an  Englishman, had  likewise  been to  St.
Martinsville; lived there five months in 1872.  This same
patient   also nursed  during  several months  in  a ward of
the  Hospital  which  sheltered  a person who had leprosy
(case 35).
   With the exception of his mother the family of the young
mulatto  (case 35) were healthy as far back  as  his grand-
parents, and1 we  have been told  that  his mother nursed
and washed for the father of case 28—a man  who  was a
subject of this  disease, as  well as  his son.   These  facts
suggest  several  possibilities,  even probabilities :  1st. If the
mother  (the " suspicious case") has the disease she may
Tiave acquired it directly from the man she  nursed, or in-
directly from the clothes  she washed. 2d. If she has not
the  disease she may have been the means of conveying it
to her son in her  own person about her clothes, or else in
the  soiled clothes of the diseased  man  3d. Again, the son
may have acquired the disease either  by inheritance from
his mother, by contact with his  mother, or by contact with
the  diseased man  referred  to  or  some of his belongings.
4th.  Even granting that the mother is a leper it is hardly
probable that the son, who is her  eldestchild, would have
been the only  one  to  inherit a disease which did not
manifest itself  in her until she  had  borne a  number of
other children,  all of whom remain healthy.  5th. It seems
to be a much more plausible  theory   that the  disease of
the  son came from  one of the known sources of  conta-
gion, and the disease of the mother, if her's be leprosy,
.also  from a similar  source.
   The statement  of case 19 that she washed the dead body
of a leper while her hands " had wounds on them," and
afterwards contracted the  disease, looks very much as if
this was the origin of the disease.   Unfortunately the  name
«of the physician who diagnosed the case of the dead person 
62
is not given, but on being questioned recently she reiterated
this statement.
  It is customary  after rehearsing testimony to draw con-
clusions.  We have  seen that a few of these cases  are of
inherited disease,  but the majority give  no such  history;
on the contrary  there is usually a flat denial of having ever
seen or heard of a similar  case.   The  evidence that the
disease has  been acquired in an infected district, or by as-
sociation with other cases, or by actual contact,  is more or
less valuable. It is not entirely conclusive, however, though
the history of the woman washing the dead body of a leper
when her hands were in a condition to absorb infective
virus, and the Englishman  nursing in a  ward with a leper
while his thumb was sore, points  very forcibly in  the di-
rection of inoculation.
  Treatment.—Unna's plan of treatment with the so-called
resolvents has been pretty well tested as regards ichthyol,.
pyrogallol, resorcin  and salicylic  acid, the latter being
usually combined with one  of the former.   Their action
upon the face has been  in  no case permanently  satisfac-
tory either in strong  or weak ointments.  Made into a paint
for the body, with traumaticine or flexible collodion, they
have been very useful.  Ichthyol, administered  internally,
either  in liquid or pill form, as much as six grains a day,
has given entirely negative  results.  Chaulmoogra oil  is
still the best remedy which the author  has tried, acting at
times almost as a specific, and always (when tolerated) as-
a tonic and  regulator of the  bowels.  Old cases, particu-
larly those of the anaesthetic  variety, are not much bene-
fitted by the oil, but  if pushed rapidly  in recent cases to
the point of toleration (thirty drops to  a drachm  may be
given at a dose) visible improvement may  be  looked for.
Under this treatment case 31 made such rapid improve-
ment that nearly every erythematous or disfiguring spot had
disappeared in the course of six months.   Chaulmoogra oil
as an  ointment has been used very  little, on account of its
high price, the  majority of patients  being very poor; be- 
63
sides, the resolvents are more generally beneficial asexter
nal  applications.
   Gurjun oil is now being tried in several cases, but its ef-
fects have not yet been accurately ascertained.
                       CONCLUSION.
   These cases have not been seen and studied in a corner.
In the milder ones the  author  has added to his diagnoses
the unqualified concurrence  of Dr.  J. H. Bemiss and Dr.
F. W. Parham, who are both familiar with the disease.
   Leprosy is undoubtedly increasing in  this city—slowly,
but steadily ; and the author is not aware that any Louis-
iana  physician has ever  before reported half  as  many
cases in New Orleans.  To  what we should attribute the
spread of this loathsome disease it is impossible to say with
any  certainty.   Malaria, syphilis, debilitating diseases, un-
sanitary surroundings, improper diet, etc,, were undoubt-
edly predisposing causes in some  cases, but beyond this all
is obscurity.
   It is not intended to  discuss here the  contagiousness or
infectiousness of the disease.  Suffice it to say that, after a
the study of these and other cases, the writer believes that
leprosy maybe communicated from a leprous to a non-lep-
rous person  by means of a specific virus,  which acts some-
what like the specific  poison of syphilis, depending  upon
thin or  denuded surfaces for its  absorption, and which re-
mains potent, very probably, for an indefinite period of time.
Syphilis,  on the  other hand, runs  a much more rapid
course, and virulence of the poison  diminishes  with age,
even wrhen the disease is  untreated.  But howsoever the
disease may be acquired  the  question to  be  decided is,
What shall be done with the lepers? To leave them at their
homes were  to create just so many possible foci of disease,
liable to communicate it to others about them, and by mar-
riage or otherwise  leave their  puny offspring as a burden
to relatives and a menace to the community.  The present
practice of  admitting them to  the Charity Hospital is  an
imprudence  justified only by the necessities  of  the case. 
64
A separate ward for them within the institution would still
be a great risk  to  the inmates, and  complete separation
under the circumstances would be impracticable.
  The only plan that  seems likely to  prove of permanent
benefit to all concerned is co?nplete and permanent isolation
of the lepers. Science has moved very slow in this matter,
and the ancient  methods  of  Moses have not been super-
seded by anything better at the present day.
  It is the universal experience, tested time and time again,
that whenever hospitals for leprosy have  been formed and
the lepers separated from the  rest of the  community the
disease has ceased to spread.  This  method was  prac-
ticed long ago by the  Jews; it was practiced in Europe in
the middle ages; it is  practiced now at Bergen in Norway,
and at Molekai in the Sandwich  Islands.   Indeed there
was once a hospital for lepers  in the city  of New Orleans,*
which continued in existence until all its  imates were re-
moved by death or transportation.
  To accomplish segregation of lepers in Louisiana string-
ent laws  must be  enacted and certain general  rules  ob-
served, for the creation  of which the following proposi-
tions are suggested:
  i.   A hospital or lazaretto to be conducted  at the ex-
pense of the State, and  situated on high ground  in the
rear of the city;  the same to be surrounded by  a  plot
of ground which the  inmates may utilize as  a  truck farm
and  for outdoor exercise.
  2.   Physicians throughout the State to be compelled by
a law more urgent than the one now  existing in Jewell's
Digest (ordinance No. 6022, A. S., art.  41) for the  city of
New Orleans, to report to the Board of Health all cases com-
ing under  their knowledge, as  well as occurring in their
practice, of persons suffering from symptoms of leprosy or
suspicious thereof.
   3.   A committee of experts, appointed by the Board of
*Gayarre's History of Louisiana, Spanish Domination, p. 167. 
65
Health, to which shall be referred for diagnosis allpersons
so reported, and whose decisions shall be final.
   4.  When a case is decided to be leprosy it shall be sent
to the lazaretto, to be there confined at  the expense of the
State ; all personal communication with  the  outside  world
to be interdicted, and intercourse with  friends  permitted
only where bodily contact is impossible.
   5.  With clean, hygienic surroundings, substantial  and
wholesome diet, together with the means of active diversion
and intelligent medical treatment, the pangs of  separation
from relatives will be felt less by the victims of the disease
(who are too glad to hide themselves during its latter stages)
than by relatives on the outside ; and the  lives of patients,
to which they  are entitled, will thus be materially prolonged.
   6.  Lastly, by such segregation only  can the community
rid itself of a most loathsome, repulsive and unclean disease. 
 
LEPROSY IN  NEW ORLEANS.
              By HENRY W. BLANC, M. D.,

Dermatologist to Charity Hospital; Lecturer on Dermatology, Tulane University of
      Louisiana ; Instructor in Skin and VCnereal Diseases, New Orleans
           Pofyclinic;  Dermatologist to the Touro Infirmary.
L. GRAHAM U SON, PRINTERS, 101 GRAV1ER ST., N. O.
 
 
 
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WC 335 EUtL 1889




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