Other peoples are represented as follows: Norwegians, 22; Icelanders, 11; Swedes, 8; Chinese, 20; Japanese 1; Germans, 12; from the Bahamas, 12; Cuba, 6; other West Indies, 4: Mexico, 3; Ireland, 6; England, 3, France, 3; Italy, 3; Spain, 1. There are other foreign cases, but the nationalities of these had not been given to the commission. The commission reports that of the States and territories, twenty-one are known to have lepers." The States that have the largest number recorded are Louisiana, 155; California, 24; Florida, 24; Minnesota, 20; North Dakota, 16.

It has been the general belief that there were no American-born lepers in the northwestern States, where the population is made up largely of Scandinavians and their descendants, but this statement can no longer be maintained, for I now have knowledge of three young men, Americanborn, who have contracted leprosy in Minnesota.

There is but one institution in the United States known as a home for lepcs, and it is in Louisiana. It has had a somewhat checkered career, and has been maintained under great disadvantages. It has been well described in a recent article by Dr. Isadore Dyer.

Carefully studying facts it would appear that provision for the care of lepers in Canada was an inheritance rather than a product of legislation; that the care of lepers in Mexico began with the invasion of Cortes and that the methods of caring for them had been but little if at all improved upon in that country since his time. That provision for the care of the lepers in Cuba was made at an early date by a Jesuit with philanthropic tendencies. Probably little if any improvement was made in the care of these unfortunates from the time of the establishment of the San Lazero Hospital in 1681 up to the occupation of the island by American troops. From personal knowledge I know that the life of the leper in many, if not all, of the other West India Islands is one of existence only. The action taken in Hawaii with regard to the lepers was forced upon the people before the time of American occupancy. It appears that of all the countries embraced in our Association, the United States is the only one that has made no provision for its lepers. At the same time most of the countries that pretend to take care of their leprous have little to boast of.

The commission appointed from the Marine Hospital Service recommends, one or preferably two, national leprosaria for the care of these unfortunates in the United States. It recommends the selection of sites covering broad areas in healthful localities where the lepers can have unlimited out-of-door exercise and occupation. It recommends that these homes should be made attractive and comfortable so that the unfortunate victims of this disease, instead of hiding their condition, may make it known and request admission to these public institutions.

With our present knowledge of leprosy in the countries which we represent and the methods employed in its care, it seems to your committee advisable that the resolution adopted by this Association at the Indianapolis meeting in 1900 be reaffirmed, and that the work of pushing legislative action bearing upon this point be referred to our legislative committee.

The resolution referred to reads as follows:

“WHEREAS, It is a known fact that lepers are found in Canada, the United States and Mexico; that these lepers represent immigrants of many nationalities, together with some Americans; that the exclusion of leprous immigrants is impossible; that the tendency to importation of leprous immigrants in the future will be greater even than in the past; that the danger of infection of American residents abroad and the importation of the disease through these channels is greatly increased; therefore, be it

Resolved, That this Association places itself on record as favorable to the establishment of national leprosaria, which may serve not only as a refuge for lepers, but also as a home and hospital, making their lives tolerable so far as possible, furnishing employment to those who are able to work, and giving skilled medical care to all cases, with the intent of possibly curing some, and making the road to death less wearisome and painful than it now is to others."

The evening session was called to order by Dr. H. P. Walcott. The evening was devoted to a "Symposium on Yellow Fever," papers being read by Drs. Liceaga on "Yellow Fever in Mexico;" "Information on the Orizaba Yellow Fever Epidemic," by Dr. del Rio; "The Mosquito as the only Cause of Yellow Fever," by Dr. John W. Ross, U. S. N.; "Method of Transmission of Yellow Fever," by Wm. C. Gorgas, U. S. A.

Dr. Liceaga presented statistics of the disease along the Mexican coast. In Vera Cruz there were 877 cases in the recent epidemic. It was notable that comparatively few cases developed on the Pacific coast. The death rate was low, largely due to the measures employed.

Vera Cruz has adopted a mosquito crusade and was working aloug other lines. The mosquito theory was generally accepted in Mexico and patients were now isolated so that the mosquitoes could not reach them.

Dr. Ross read a most graphic paper in argument for the mosquito theory relating the history of the disease in Havana. For 140 years previous to 1901 Havana had been the home of yellow fever. After eight months of American occupation and antimosquito sanitary work the disease disappeared from Havana altogether. The writer reviewed the work done in Havana by the yellow fever commission and the experiments which were conducted to prove the mosquito theory.

Dr. Ross emphasized the high value of the cleaning up of Havana and its sanitary relation to all diseases, yellow fever included.

Dr. Iglesias, of Mexico, said that we can understand that insects are carried on railroad cars. They scatter disease in the atmosphere as well as by bite. The first case of fever in Orizaba was in the wife of a railroad employee, and it was found that she had been bitten at the station by an infected mosquito. The doctor argued the advisability of disinfecting freight and passenger cars exposed to mosquito infection.

A paper prepared by Dr. Gorgas was read for him, arguing the belief that the yellow fever germ may live only in the body of man and in the mosquito. He took up the fomites transmission of the disease and pointed out that the effect of its evidence was that at the time that evidence concerning delayed transmission had been collected the doctors had not questioned the transmission by fomites but were concerned merely as to how the transmission took place. This did not prove that by fomites alone the disease had been conveyed.

As arguments favorable to the mosquito theory the following were advanced :

Yellow fever never continues after frost; it is never contracted at high altitudes. It is never carried to countries far from the home of the mosquito that transmits the disease, as in India and other Eastern countries, to which tuberculosis and other diseases transmitted by fomites have been carried. If the disease were conveyed by fomites, which are not always destroyed by cold weather, then the disease would not cease to spread after the beginning of cold weather. If it could be contracted by transmission by fomites it could be contracted at high altitudes, but it was explained that while cases removed from the sea level or the coast might develop in high altitudes they never were contracted there. Persons moving from the coast to the City of Mexico were sometimes taken with the yellow fever at the latter place, but the cases had been contracted at the sea level, If yellow fever could be conveyed by fomites, why would the fact that the yellow fever mosquito, stegomyia, cannot live in winter affect the contraction of yellow fever in winter? In addition to all the arguments showing that yellow fever is not contracted through fomites in such cases, it might reasonably be expected to arise from the presence of fomites if they were the means of transmission. It was further related that, as in the experiments in Havana, most careful experiments had been made to try to

infect with bedding and clothing presumably laden with fomites, persons subjected to the contact of those articles, and that the attempts to so infect had failed completely.

Prof. Beyer, of Tulane, reading on "Observation of Disease Transmission" through mosquitoes, said "it is evident from the results of the experimental work of Ross, Grasse, Begnaun, etc., on Malaria, and that of Reed and Lazear on yellow fever, corroborated and borne out in even the smallest details in Cuba through the efforts of the yellow fever Institute of the Public Health, and Marine Hospital Service in Vera Cruz, results which have not, but will soon be, that we can no longer speak of the transmission of disease by mosquitoes as being theoretical, but must accept it as a fact. From the deductions which. we are forced to make from the results of experimental works in all diseases in which mosquitoes have been at first suspected and now stand convicted of being the host of the causal agents of these diseases, transmission by fomites can no more be considered tenable by us. A careful consideration of the cycle of development of these two diseases, as brought about by the mosquitoes, through the agency of organisms other than vegetable, must also convince us that bacteriologic methods in the combating of either malaria or yellow fever, are no longer indicated, but must be dealt with by measures better suited to the nature of the causal agents.

"But on the other hand, it would be unreasonable also to suppose that other mosquitoes still uninvestigated may not be intermediate hosts of other diseases, or that even those which are now known to convey animal parasites may not also be the carriers of bacterial diseases. While all further doubt in regard to the cause and transmission of malarial diseases has been removed by the complete and general knowledge of the life of their parasites and hosts, and by a thorough understanding of the laws which govern the alternation of generation, we are following at the same time closely through similar but less completely known lines into the cause of yellow fever.

"In view of the fact that it has been clearly established that a known mosquito is the truism of yellow fever, the suggestion is justified that the efforts of quarantine officers should be directed in the largest measure towards the destruction of this mosquito.

"In the event of a case of yellow fever appearing in the midst of any community the attention of the Boards of Health must be given to the mosquitoes and the protection against them of the patient. The latter precaution will be a guarantee of self limitation of the cause and the fortifying against its rejuvenescence."

The discussion of these papers followed:

Dr. Carlos J. Findlay, of Havana, Cuba, health officer for the island, was first recognized. He said he had investigated the air for twenty years in Havana, trying to find a cause for the spread of yellow fever. The scales fell from his eyes, he said, when he read the report of the first American commission, which was in effect that the disease was transmitted by inoculation and that this was accomplished through the agency of the mosquito. Since then he had applied the theory for himself, making numerous experiments, which, he said, supported the conclusion that this insect was the means of spreading the disease. In Havana they had such a perfect system now of handling the disease, all directed against the operations of the mosquito, that the disease had been driven off the island practically.

Dr. Souchon did not antagonize the theory of mosquito transmission. In fact, it was not a theory now, but a demonstrated fact. It was the duty of every health officer to recognize this fact, and destroy mosquitoes as far as possible.

"But I do not believe we are prepared to say that the mosquito is the only means of the transmission of disease," de. clared Dr. Souchon. He said he had been through many epidemics and had studied the whole question extensively, besides making many experiments. "After a close study of the question, I have reason to believe there is some other means of transmission. What it is I cannot say. It may be fomites, or yet something we know nothing of at all." He referred to the cases reported by him in the New York Medical Journal, where fomites, by the natural rules of reasoning, caused the disease to break out in cold climates and across seas from where the original disease was located. Thirty per cent. of experi ments with mosquitoes had failed, and as large, if not larger, per cent. of other experiments had proven unsuccessful, which was conclusive proof that no fixed principle had as yet been evolved further than that mosquitoes were one means of transmission.