that such infected individuals be returned to the port whence they came. Dr. Hamilton's position as a Supervising Surgeon-General of the U. S. Marine Hospital Department, enables him to institute a protective measure in this direction which will render it improbable that any developed cases of leprosy can get into the country through vessels from foreign ports. No provision has been made, however, for protection as regards intercourse between the United States and her neighbors on the North and South, Canada and Mexico. Besides, with the length of time, years even, during which the seeds of the disease may either remain undeveloped or present only slight evidences of its presence in an individual, it would be altogether unlikely that a medical officer who had not been familiarized with the diagnostic features of leprosy could be able to detect such a case when presented to him. The question as to the degree and extent of segregation that should be instituted, as regards the cases of leprosy already in the country, whether imported or originating here, is one which requires our careful consideration, both from a sanitary and humanitarian standpoint. We have an authority, sanctioned by successive ages of experience, that a leper is dangerous to his fellow man by reason of the plague which he carries about with him. Whether the liability to contract this disease is limited to the necessity of immediate and special contact of abraded points on the mucous surfaces, or whether infection may result from ordinary relations of life between individuals who are brought near each other, I do not know, and consequently cannot pretend to express an opinion. But that leprosy is conveyed from individual to individual in some manner, app ars established beyond all question; and that such laws should be enacted as will authorize the health authorities to deal with this question in a manner that shall best guard the clean from the unclean, and yet with humane consideration for the latter, would appear right beyond controversion. When the general Government has instituted such regulations as are necessary and practicable for guarding the national boundaries against the ingress of any additional cases of leprosy, it has reached probably the limit of its ability to aid us in this matter. What steps to take in regard to those cases already ex isting or which may hereafter develop within the borders of the several States, is a responsibility which rests with each State to decide for herself, as there does not appear to be any constitutional power authorizing the national authorities to interfere without consent of the States themselves. Louisiana already has a leper hospital, and there can be no doubt of the existence of a sufficient number of cases of this loathsome malady in several other States to indicate the advisability of a similar provision for the segregation. and care of these unfortunates; indeed, it appears to me that the known residence of a single case of leprosy within the borders of a State, should be sufficient ground for providing suitable hospital accommodations for the isolation and care of such an individual. I think that all known cases of the disease should be segregated and humanely cared for by the State, and at the expense of this latter. There certainly can be no doubt of the right possessed by the legally constituted health authorities to take such action regarding the disposition of cases of leprosy as is done with other diseases of a contagious nature when public health and welfare are placed in jeopardy; indeed, our duty to do this is emphasized as specially incumbent in this connection, a twofold duty : first, to prevent the propagation of a disease as insidious and mysterious in its approach as it is cruelly unrelenting in the clutch of its foul embrace, only relaxing when death comes to relieve, and second, to make proper provision for the care of those who, through no fault of theirs, have become outcasts from society, branded with loathsomeness and doomed to a lingering death, often, doubtless, exaggerated in its horrors by neglect and want. If I were a leper, it appears to me that I should seek such a place of refuge as a haven of rest; but if I did not take this course from inclination and of my own free will, I believe that there should be an authority existing and exercised to compel me to do so. One of the chief difficulties, doubtless, in pursuing this policy would be the concealment of cases from the knowledge of the health authorities and an active antagonism on the part of such cases, or of those most nearly interested in them. The extract just read by me from Dr. Porter's report of his effort to investigate in this direction down at Key West last year, and to ascertain the amount of leprosy on that island, illustrates this point. However, I have no doubt that the few cases said to exist there can be located, if such is the fact. We have no knowledge of the existence of this disease in Florida elsewhere than at Key West, and doubtless we must thank Havana for this contribution to our stock; as the conclusion is as natural as the evidence makes it probable that if there are a few cases of leprosy at Key West, they owe their origin to that nursery of infection located so near here, and it is from this source that we must apprehend danger and guard against further importations of such an undesirable character. The restless and thriftless tendency pervading a large majority of the Cuban population which comes to Florida and the facility of inter-communication between Tampa, Key West and Havana render the risk of having cases slip in through this channel not inconsiderable. Of course, the order lately issued by Surgeon-General Hamilton will give comparative, but not absolute protection. There are many irregular channels which I fear cannot be thus supervised. As before stated, I have no knowledge of any cases of leprosy in Florida except those mentioned by Dr. Porter as being in Key West; but one.or more isolated cases may possibly exist elsewhere. Should any of you be informed of such it will be a matter of interest to me personally and of value to me as one of the State health officials to be informed of it. In conclusion I must disclaim the intention of attempting to place before you anything besides the garnerings of others; to apologize to those of you who are already famil iar with the subject matter presented; and to ask that my paper be permitted to accomplish one of the purposes intended in its preparation, that of drawing out the experience and views of other members on this subject. ANNUAL REPORT, BOARD OF MEDICAL EXAMINERS FOURTH JUDICIAL DISTRICT, STATE OF FLORIDA. Number of certificates issued from December 12, 1890, to January 7, 1891.... Number of examinations held... Number of certificates issued upon examinations. 74 5 4 1 4 78 Of the number of applicants for certificates who were rejected by the board, one failed to pass a satisfactory examination; one did not hold a diploma or other license as required by the law prior to the passage of the present act regulating the practice of medicine; one was referred to the Board of Homeopathic Examiners; one held diploma from a bogus school, i. e., Vermont Medical College, Rutland, Vermont. Certificates issued in Duval County. 45 9 6 1 74 Diplomas from the following schools of medicine were pre sented: Cincinnati College of Medicine and Surgery. Columbia College, Medical Department. College of Physicians and Surgeons, Baltimore. 2 1 3 3 last year, and to ascertain the amount of leprosy on that island, illustrates this point. However, I have no doubt that the few cases said to exist there can be located, if such is the fact. We have no knowledge of the existence of this disease in Florida elsewhere than at Key West, and doubtless we must thank Havana for this contribution to our stock; as the conclusion is as natural as the evidence makes it probable that if there are a few cases of leprosy at Key West, they owe their origin to that nursery of infection located so near here, and it is from this source that we must apprehend danger and guard against further importations of such an undesirable character. The restless and thriftless tendency pervading a large majority of the Cuban population which comes to Florida. and the facility of inter-communication between Tampa, Key West and Havana render the risk of having cases slip in through this channel not inconsiderable. Of course, the order lately issued by Surgeon-General Hamilton will give comparative, but not absolute protection. There are many irregular channels which I fear cannot be thus supervised. As before stated, I have no knowledge of any cases of leprosy in Florida except those mentioned by Dr. Porter as being in Key West; but one.or more isolated cases may possibly exist elsewhere. Should any of you be informed of such it will be a matter of interest to me personally and of value to me as one of the State health officials to be informed of it. In conclusion I must disclaim the intention of attempting to place before you anything besides the garnerings of others; to apologize to those of you who are already famil iar with the subject matter presented; and to ask that my paper be permitted to accomplish one of the purposes intended in its preparation, that of drawing out the experience and views of other members on this subject. NOTE. Since the above was read before the Florida Medical Association, a death from Leprosy has been officially reported to the office of the State Board of Health as having occurred in Pensacola. |