that it was from the published statements of Dr. Holmboe, who visited this State in 1863, and of Prof. Boeck, the date of whose visit was 1870.

My next step was to write a letter to the Rev. L. A. Johnston, pastor of the Swedish church in Des Moines, and from him had the following answer:

"In reply to your letter, I can say that I have never heard of a case of leprosy among the Swedes or Norwegians in Iowa, or in any other State in America, or elsewhere."

As both Holmboe and Boeck located cases in Winneshiek County, near Decorah, I asked Dr. Small, health officer of that city, to investigate the matter, which duty he very prompfly performed. The result of his researches being shown in the following extracts from his report of the date of August 29, 1883:

He begins by stating that though he had practiced medicine in Winneshiek and the adjoining counties for twenty-seven years, yet he had never heard of a case of leprosy. Interviews with prominent Norwegians in the town of Decorah yielded no information. Finally, he got a clue from T. E. Egge, the County Auditor, who remembered that, when he was a boy, Dr. J. A. Holmboe and Rev. Mr. Koren, of Bergen, Norway, visited his father in search of cases of leprosy.

The Rev. Mr. Koren being still alive, Dr. Small paid him a visit, and from him had the following interesting information: "Dr. Holmboe visited this country in 1863, and made a tour of inspection in regard to leprosy among Norwegians. Both Dr. Holmboe and Rev. Mr. Koren were familiar with the disease in the hospital erected in Bergen 200 years ago. Johannes Simonsen was pointed out, whom both gentlemen knew in Norway (this is Holmboe's second case), but he is now living, 75 years old, in good health, and has never had any symptoms of leprosy, nor has any of his family.* Dr. Holmboe saw, in 1863, the death here of one man, supposed to be Knab. Ericsen (Holmboe's third case). Dr. Koren had in his congregation a case of leprosy, a certain N. W. Remene, who died April 6,

There is some mystery here, for Dr. Holmboe knew leprosy well, and therefore could not have been mistaken; neither could the patient have recovered-such an event being unknown. The mistake arises from the unfortunate repetition of the same names, both Christian and surnames, among the Scandinavians.

1877. He had lived in this country fourteen years before the disease made its appearance. He was a horse-driver in the West, camped out and lived on poor food; none of his family, however, have been since affected.

Finally, the reverend gentleman stated that for thirty years he has traveled over all of Northern Iowa and Southern Minnesota, and, with these exceptions (four cases), he has neither seen nor heard of any other cases of leprosy; and it is his opinion, as it is also of Dr. Small, that there is not a case of the disease in Northern Iowa or Southern Minnesota."

Of the eighteen cases of leprosy observed by Prof. Boeck in 1869-70, three were in Iowa.

1. Edward Nielson Taraldsgaard, Hesper township, Winneshiek county; then (1869) 23 years old; two years in America; brought the disease with him from Norway.

2. Ole Torkildson Fosse, Pleasant township, Winneshiek county; then (1869) 30 years old; disease appeared three and one-half years after his arrival in this country. Had, in Norway, leprous relatives..

3. Ole Iverson Dale, Winneshiek county; then (1869) 43 years old; brought the disease from Norway, does not know of any leprous kin.

This information is derived from a special report of Dr. Grönvold, of Norway, Minnesota, dated Sept. 1st, 1883, a copy of which Dr. Hewitt, Secretary of Minnesota State Board of Health, was kind enough to send me.

The cases are tabulated thus, all being in Winneshiek county:

It thus appears that in the past twenty years there have certainly been in Iowa seven cases of leprosy, all now dead, the latest dying April, 1877.

Winneshiek county, in 1880, with a total population of 23,

938, had a foreign population of 7,862, of which 4,095, or 52 per cent., were Scandinavians (Swedes and Norwegians). The whole State had then 39,145, so that of the Scandinavian population of the whole State, Winneshiek county had about ten per cent.

As yet we have no knowledge of the existence of the disease in a child born in Iowa, but that such an event is possible Dr. Hyde's report of a child born in Minnesota, of Swedish parentage, the father having leprosy in the tubercular form, affected with the disease, shows.

Many persons may think the danger of the spread of leprosy in this State is small, but as Dr. Billings significantly remarks: "The danger is, no doubt, small-that is to say, there is a very small risk of a very small danger-but it exists, and now is the time to guard against it."-(Lectures on Germs, San. Eng., March 29, 1883, p. 388.)

APPENDIX.

MINNESOTA. In this State Boeck saw four cases in 1870. In 1878 Dr. Grönvold reported four cases; two dead, in 1878 (one of Broeck's cases), and two living.

Circulars were sent to Norwegian physicians and clergymen, and twenty answers were received from eleven counties. Only two cases of leprosy were reported, both of the anesthetic form, and both natives of Norway. One of these cases had the disease in Norway, but was first seriously attacked seven years after coming to this country, nine years ago. He has grown

children-all well.

Dr. Grönvold knows of three cases in his vicinity-Holden, Goodhue county-one male and two females. All brought the disease from Norway. Two have children and grandchildren, all well. In the past ten years five lepers have died in his vicinity; but in one of these (Boeck's No. 2) the disease had stopped years before his death. Of these five lepers two were married and have children and grandchildren—all well. He has in the same period other cases in transient persons, but has lost trace of them. He thinks there are other cases in the State, but admits the difficulty of discovering them, owing to the great disinclination, both on the part of the patients and their relatives, to confess the existence of the disease.

Of Boeck's four cases in this State, Nos. 2 and 3 are dead. No. I is yet living. The other cannot be traced.

As leprosy is steadily diminishing in Norway, as immigration is its only source, it must decrease here also. In Norway there were, in 1856, 2,113 lepers; in 1874 there were 1,832; in 1878 there were 1,681.

WISCONSIN. Of leprosy in this State, where Boeck saw nine of his eighteen cases, the only information I have been able to find is in a letter of Dr. J. T. Reeve, Secretary of Wisconsin State Board of Health, to the Sanitary News, dated August 27, 1883, and published September 15, 1883, in which it is stated that Dr. Knut Holgh, a member of the State Board, has, since 1869, been investigating the subject, and in the fourteen years has seen but four cases, two of which, if not all, are now dead.

ILLINOIS. Of leprosy in this State, where Boeck found two cases, I can find no record.

PHYSICAL PURIFICATION.*

In speaking, a few months ago, on one of the departments of physical purification, I seem to have startled the proprieties of many of the people by the assertion that absolute cleanliness-cleanliness of the body and mind, and all that belongs to them-is the beginning and the end of the sanitary design, and that such perfect cleanliness would wipe off all the diseases which cause at this time the leading mortalities. I do not withdraw from that statement a syllable, and I again place this subject of national purification first on the paper.

Into all the varied studies connected with this argument it were impossible to enter. It will be fittest to take two of the Augean stables which have to be cleansed.

Underground Purification.-The complete removal from our communities, day by day, of all their organic excreta, is still an unsolved difficulty, which, remaining unsolved, is a block to every step of perfect purification.

We are yet distracted with the debate ever going on be

*Abstract of paper on Vital Steps in Sanitary Progress, by Benjamin Ward Richardson, M.D., F.R.S., read before Society of Arts and published in the Journal of the Society.

tween the advocates of the combined and the separate systems of drainage. Shall our organic excreta go with the stormwater into the river and sea, or shall the water go to the river and sea, the sewage to the land? Unlike our neighbors on the other side of the channel, we have agreed to give up the cesspool and to divide on two questions which they have not, seemingly, admitted, and one of which—that of disposal in running streams—they have long legally prohibited. But in giving up the cesspools, have we greatly advanced, so long as we pollute the running stream and lose the natural fertilizer of the land?

Looking back on all the controversy for the last thirty years, and reading back still farther, I feel we have not advanced. I do not think it would be wise to return to the most scientific system of cesspoolage, but I cannot conceive any next worse plan than the plan of passing the sewage with storm-water, even on the most scientific system, into running streams, and robbing the land of its greatest requirement for its fruitfulness. I submit, therefore, as a point to be argued out, that this society can never be soundly assisting sanitation until it assists none other mode for removal of excreta than the separate sys

tem.

In saying so much for the separate system I do not, however, wish to contend for the introduction of that system in the hard and unchanging line which some would fight for. I know quite well, from the inspections I have had to make, officially, of different towns and districts, that there are centres of population in which the separate plan, in its rigid application, is not suitable. A town may have no river into which its stormwater can run. A town may have a river but no land near to it which can be cultivated.

These conditions may affect details, while they need not affect the principle. For storm-water for which there is no natural outlet there is always the good resource at hand of storing it for domestic use. For sewage that cannot be utilized on land near to the community which yields it, there is always land not far away which is waiting for it. In these days there need never be necessity for any difficulty in the removal of sewage day by day from the largest centres of population, presuming always that it is not mixed and increased in volume by

storm-water.