the tuberculous insane in this hospital as follows: "The sputa of the suspected case is examined, and if the bacilli are found the patient is placed in a single room, the walls of which are painted and can be easily disinfected. The furniture consists of an iron bedstead, which is readily cleaned. There are no curtains to the windows and no carpet on the floor. The patient is persuaded, if possible, to expectorate into a vessel, which is disinfected with mercuric chloride. If the patient expectorates about the room no harm can be done, however, as everything can be readily washed with a disinfectant. The bedding is properly cared for, and is used for no other bed. After the death of the patient the room and all of its contents are thoroughly disinfected.”

It may be well to place Doctor Wade's opinion, relating to tuberculosis among the insane, against the older views which I have already given. He states, as reasons for a high mortality from this disease in these hospitals: First, the fact that the physical condition of the insane patient is very much depleted on admission; second, the necessary confinement in the building; third, the difficulty of isolation; fourth, the lack of proper care and disinfection; fifth, the fact that many of the patients do not complain of their ailments and that the tuberculous process is well established before discovered.

Doctor Tomlinson, superintendent of the state hospital for the insane at St. Peter, Minn., believes in the transmutation of insanity and phthisis. At the same time, he believes that most of the cases of tuberculosis in these hospitals originate by infection while in the hospital, and that patients having a direct heredity of phthisis are not likely to die from this disease. In proof of this he quotes from the hospital's statistics as follows: "During a period of two and a half years, out of 695 patients admitted, seventy had a history of phthisis in the family. Five patients were suffering from phthisis when admitted. During this same period, nineteen patients died of phthisis, and not one of these had an heredity of that disease."

He believes that the materies morbi for tubercular infection is always present in the old style hospital, and that the poor hygienic surroundings, due to over-crowding, have much to do with its development. This is illustrated by the fact that at times a patient, who becomes infected with tuberculosis and is rapidly failing, may improve and apparently recover when placed under better sanitary conditions.

In concluding, let me offer the following propositions:

1. The old ideas relating to the interchangeable character of the phthisical and insane diatheses are not worthy of consideration

when the question of isolation of the tuberculous in hospitals for the insane is under discussion.

2. The old ideas as to the close relationship between tubercufosis and insanity furnish the only excuse (and a very poor excuse it is) for the non-isolation of the tuberculous insane.

3. The insane should be classed as irresponsible invalids, and the course pursued by those who have them in charge should be regulated accordingly.

4. The insane may be more susceptible to the infection of tuberculosis, for reasons already given, and, consequently, the means taken to prevent such infection should be most thorough.

5. The question of controlling the sane tuberculous may be a difficult one to settle, for the actions of the infected ones cannot always be restricted. It is quite the reverse with the insane. Their manner of life is under control, and without any additional hardship to these unfortunates, the danger of spreading infection can be reduced to a minimum.

6. There can be no doubt but that most of the tuberculosis in hospitals for the insane is the result of infection.

7. Over-crowding in these hospitals is one of the chief causes of the high mortality and the general infection from tuberculosis.

Ex

8. Those who have charge of the insane, governments, hospital trustees, and superintendents, are responsible for their care. posure to tuberculous infection, through carelessness or indifference on the part of such guardians, should be considered as criminal negligence.

Dr. Felix Formento, New Orleans, La., offered the following resolution: Resolved, That it is the sense of this conference that tuberculous patients should be isolated from other inmates in our hospitals, asylums, prisons and penitentiaries.

Upon motion, properly seconded, resolution was adopted.

LEPROSY IN MINNESOTA.1

BY H. M. BRACKEN, M. D.,

Professor of Materia Medica and Therapeutics, University of Minnesota; Secretary and Executive Officer of the Minnesota State Board of Health.

In Allbut's "System of Medicine" (Vol. III., p. 46), referring to the Norwegian lepers of Minnesota, Wisconsin and Dakota, it is stated that these have diminished from 160 known cases to about a dozen. This statement is undoubtedly taken from the report of Dr. G. A. Hansen of Bergen, Norway (1888), who says, "of about 160 lepers who have immigrated into three states (Wisconsin, Iowa Minnesota) thirteen are alive, whom I have seen myself, and perhaps three or four more. All the others are dead" This statement refers to the known lepers that left Norway and settled in the Northwestern States. At another time, Dr. Hansen says: "The number of immigrated lepers from Norway is much greater than I had any idea of from the knowledge I could gather at home. My friends, Dr. Hoegh and Dr. Gronvold have given me the names of many lepers here in America whom we did not know to be lepers when they left Norway." The figures quoted from Allbut's "System,” therefore, refer to those only who were known to be leprous when they left Norway, and hence are misleading, as well as incorrect. In 1886 the Minnesota state board of health first reported upon the lepers of the state. An attempt has been made since that date, and I think with fair success, to keep a record of all lepers in the state. The accompanying table (p. 275) will serve as an interesting text:

We have knowledge of fifty-one lepers having resided in Minne sota. Of these seventeen had died before 1890. Of the thirty-four added to the records since 1890, eighteen were first reported upon in 1891, two in 1892, three in 1893, two in 1894, two in 1897, and seven in 1898, to date (September 15th). Little is known of the nationality of the seventeen who died before 1890, but from various reports it is safe to presume they were all from Norway. Of the later thirty-four, twenty-nine were probably from Norway and five from Sweden. Of the five from Sweden one was reported first in 1894, the other four in 1898.

Of those who might have belonged to the 160 known lepers that immigrated from Norway previous to 1888, this list cannot include

'Read at the Ottawa meeting of the American Public Health Association, October, 1898.

'Ch. Gronvold, M. D., Report, July 1, 1894.

more than seventeen. There is a possible total of twenty-nine cases in whom the disease first appeared in the old country, but it is not at all probable that more than twenty-two of these were included in Dr. Hansen's list of 160.

Undoubtedly some of those who have reported the disease as first appearing after they had landed in this country have not told the truth. It would be fair, probably, to say that twenty-five of the fifty-one Minnesota lepers had the disease before leaving Europe.

Twenty-one is probably the highest number of lepers known to have been living in Minnesota in any one year (1893). At present thirteen are known to be living in the state. There may possibly be three more living, from whom we can secure no reports at present, and in addition a few unrecorded cases. Of these fifty-one known cases but nine were females. Of the latest record (thirtyfour cases) twenty-one are known to have been married (fifteen men and six women), and twenty of these married lepers had children. It is quite possible that the other one (a woman) had children also. These twenty-one married lepers had from one to eight children each. We have knowledge of at least seventy-eight children born to these lepers. It is not known how many of these children were born after the parent was recognized as leprous, but it is safe to say a large proportion of the seventy-eight. Not one of these seventy-eight children has become leprous, and in no case has the leper transmitted the disease to the companion in wedlock. In twenty of these lepers the disease is said to have been the anesthetic form, in twenty-three the tubercular form, while for eight the type of the disease is not given.

Of the thirteen lepers known to be living, I can give an outline of the present condition of but six, as follows:

No. 43. Mrs. D. Born in Sweden. There is no history of leprosy in her family. Her husband, a Norwegian, states that the newspapers have reported a case, or cases, of leprosy near her home in Sweden since she left there. She landed in America (Philadelphia) in 1887, and was married in the fall of the same year at Warren, Minn., The first symptoms of leprosy appeared soon after the birth of her second child, in 1891. There was then swelling of the hands, feet and face. On March 24, 1898, inspection showed the following condition: Hands and feet blue, nodular, and swollen; face, "leonine;" hair falling out rapidly; eyebrows gone; sore throat; anææsthetic spots on extremities and face. There are sores on her legs and arms received from blows and burns due to the anesthetic condition of those parts. She has four children; two born before