408 SANITARY CONDITIONS 



were treated, eleven each year ; and in the female ward of the same institution 

 we saw a case in a girl only nineteen years old, which is a very early age for this 

 disease. At Spanish Wells, out of 150 people examined, we found eight cases 

 of locomotor-ataxia, and a thorough examination of the entire population would 

 have doubtless revealed more. At a number of other islands we found addi- 

 tional cases of this disease, always present in proportions abnormally large 

 when compared to other afflictions. 



These cases showed typical symptoms of the preataxic, ataxic, and paraly- 

 tic stages of the disease. The symptoms complained of were usually lightning 

 pains, ocular aberrations, as for instance Argyll -Kobertson pupil, in which 

 there is a reaction to light but not to accommodation, optic atrophy, the loss 

 of the knee-jerks, characteristic ataxic walk, paralysis, etc. 



In view of the small proportion of syphilitic cases in the communities 

 where locomotor-ataxia is prevalent, it would seem that some other factor than 

 syphilis must be considered the cause of this disease. From my studies in 

 the Bahamas, I am inclined to think that poor conditions of life, bad sanitation 

 and hygiene, exposure to the wind, weather, and salt water, together with con- 

 sanguineous marriages, must be regarded as important etiological factors. 

 When it is remembered that many of the people who are now suffering with 

 locomotor-ataxia have formerly been fishermen, boatmen and sailors, who have 

 engaged in diving for sponges and have remained in the water for hours at a 

 time, the possible reaction of this condition of life on the nervous system should 

 not be neglected. 



Pesplanus or Flat-foot. 



Flat-foot, owing to the habit of long standing with bare feet in the 

 water, and general poor nutrition of the people, was so common as to be 

 almost a normal condition among the poorer classes in the Bahamas. An 

 extreme degree of this condition is in the Bahamas endured with little or no 

 complaint, which in a more civilized community would be productive of 

 considerable pain and loss of function. 



Boils, Carbuncles and Infections. 



Infections occasioned by neglect, occasionally assumed alarming propor- 

 tions among the natives. There is a variety of infection following puncture, 

 ugually of the hands, by the sharp end of the leaf of the sisal plant, which is said 

 to become chronic and exceedingly difficult to heal. There seems to be some 



