THE BAHAMA ISLANDS 407 



cutaneous fat, with fatty degeneration of the bone and other tissues. The 

 bone is usually considerably absorbed. At the seat of constriction the epithelial 

 layers are greatly hypertrophied with atrophy of the papillary layer of the 

 skin. Below this is a band of fibrous tissue very thick and dense. The most 

 careful staining by several methods failed to show a single lepra bacillus. 



We were struck with the tendency of this disease to run for several gener- 

 ations in the same family. From the fact that a number of persons so affected 

 complained of rheumatic and sciatic pains, as well as from the tendency of this 

 disease to run in certain families, it would seem that some trophic condition 

 of the nervous system was the most likely explanation of its origin. 



The best treatment of this disease is, in the early stages, to make trans- 

 verse sections or cuts along the line of constriction, and later, if this first 

 method fails, to remove the affected toe. 



Talipes or Club-foot. 



We were considerably interested in the numbers of eases of this condition 

 we saw and heard about during our medical studies in the Bahamas. They 

 were generally of the congenital variety or talipes equino-varus, and usually 

 affected both feet. As to the cause of this condition, there has been much 

 speculation. It has been attributed to uterine pressure, to intra-uterine disease 

 of the cerebro-spinal axis with resulting paralysis and arrest of development. 

 It is not seldom associated with other malformations of the head, face, spine, 

 abdominal wall or pelvis. We were interested to note the influence of heredity 

 in this condition as demonstrated in a family at Hopetown, Abaco, where the 

 condition ran for two generations in the family of Capt. Samuel Malone. It 

 appears that both of his grandchildren by one son were born with congenital 

 club-feet. The births in both cases were normal, and the father and mother 

 physically and mentally were rather above the standard of the community. 

 We did not see instances of the other forms of this condition, as for instance 

 talipes equinus, talipes calcaneus, or talipes varus, but all the types we met with 

 were of the congenital or equino-varus. 



Locomotor- Ataxia. 



We were, especially impressed with the number of cases of locomotor- 

 ataxia found among the people of the Bahamas. This interesting disease which 

 is comparatively rare in the United States is unusually prevalent among these 

 Islands. At the hospital at Nassau, during 1902 and 1903, twenty-two cases 



