122 JOURNAL OF THE TRINIDAD 



the foot to the dorsum and cutting straight forward through all 

 tissues bringing the bistoury out between the toes; afterwards 

 stuffing the incision with lint to prevent immediate closure of 

 the wound which he then ! mulate up from the bottom. 



These operations were atten I b good results. The report 



which Dr. Rake wrote in February, 1893, when he had returned 

 from the Indian Leprosy Commission (an absence from the 

 colony of one year and eight months) also dealt with the com- 

 municability of the disease, and he mentions a case which s< 

 to suggest a possible communication, but lie considered its value 

 fractional, for no evidence was to his mind positive in a "Country 

 where leprosy is endemic. "Scientific proof,' 1 he adds, "will not 

 "be obtained until criminals are inoculated with leprous material 

 "in a country free from endemic leprosy." He then passes on 

 to the question whether there has been an increase in leprosy. 

 The conclusion Ik; arrives at is that "in Trinidad there has 

 " probably not been much change one way or the other, but if 

 "anything there has been a slight decrease in the pixmortion of 

 "lepers to the general population ; that in India there has been 

 "a marked absolute decrease; in Norway there was a steady 

 "decrease long before compulsory segregation was thought of and 

 "that- in tin' North Western States of North America where 

 "leprosy was not endemic, the immigration of Norwegian lepers 

 "has not been attended with any prejudicial results to the rest 

 " of the community, nearly all the imported cases having died 

 "out and no new cases having occurred." The remainder of the 

 report is made up of a summary of the six years' work and a 

 number of valuable tables. The last report was written in 

 February of last year. In this paper he narrates his experience 

 in the use of Thyroid Extract in the treatment of leprosy and 

 summing up the result says that the most powerful preparation 

 had been used without producing any appreciable effect on the 

 disease. He had also been trying blood serum therapy but the 

 results had been negative, but he expresses himself as not being 

 without hope that blood serum from lepers might prove of use in 

 early cases of the disease. 



Throughout the reports there are numerous suggestions for 

 the improvement of the comfort and the mental well-being of 

 his charges and Dr. Rake did not forget to try and interest the 

 general public in his patients. He made appeals to his friends 

 for pictures for the walls and he started a library of instructive 

 and entertaining books with the help of a grant by the Govern- 

 ment, and he made a further requisition on the public which 

 l-esulted in a large number of illustrated papers and books 

 being presented to the Institution, with games and musical 

 instruments which were much valued by the boys, In one 

 report he refers to the interest of the coolies in pictures of 



