ON the 9th of February, 1892, after obtaining a permit from the Colonial Office, I took passage in the small but stoutly-built little tri-weekly steamer "Tiger," from Dock Basin, Cape Town, for Robben Island. Amongst our fellow-passengers were visitors, merchants, a clergyman, a singing lunatic in the custody of a warder, and officials connected with the island. Our cargo consisted of fruit, poultry, beef, and other stores for a population of about 700 persons. In less than an hour after starting, we cast anchor opposite the island; and, there being no landing-stage or jetty, we found small-boats, managed by convicts clad and numbered in penal costume, awaiting our arrival.

These singular-looking boatmen rowed us near the shore, and then carried the male passengers on their backs and the women in chairs through the surf on to terra firma. The convicts on the island, about one hundred in number, are said to be chiefly murderers and diamond stealers. There is a strong current between the island and the mainland. Only one attempt has ever been made by a convict to escape by swimming, and the attempt cost him his life.

The first building I entered for the purpose of making inquiries proved to be the female ward of the lunatic asylum. Here I was referred by the attendant to the office of the medical superintendent for another permit, which was granted. Dr. S. P. Impey has medical charge of the convicts, lunatics, lepers, and attendants, comprising the entire population of the island. I found him busily occupied with one caller after another, examining and signing papers from different departments; and, instead of engaging his attention at the moment, I expressed a hope that, as I was interested in what is popularly known as the leprosy question, he would be able to see me later in the day. He readily agreed to see me for this purpose at two o’clock.

On my way to the leper wards I looked in at the little church, a rather pretty edifice, adorned with scripture mottoes disposed in large letters around the galleries, where the Rev. W. W. Watkins, the successor to the late Mr. Wiltshire, ministers to his singular congregation. I then proceeded to the male leper wards, meeting with convicts and lunatics on my way. The sun was scorchingly hot, but there was a good breeze blowing, and the ozonised air from the ocean was gratefully invigorating. I should think that the island, although only a sandbank of about 1200 acres in extent arid almost devoid of vegetation during the hot season, would be very salubrious if the conditions for health were observed. The water supply is excellent.

The first lazaretto building I entered—one of the old wards devoted to male lepers—was by no means an inviting structure. It was a large shed with low-studded walls containing a double row of beds, upon which the lepers were reclining in every variety of posture. The air was close and noisome with the evil effluvia of decaying living bodies—death in life—supplemented by the odour of influenza, which at this time was raging throughout the island. Of one hundred male lepers, no fewer than eighty, on the day of my visit, were down with this distressing disease. It has been said that a leper hospital, with its handless, footless, ulcerated, feature-swollen, and distorted patients, is as horrible a sight as a field of battle; and to the misery inseparable from a repulsive and incurable disease were now added the effects of a depressing epidemic—a most heart-breaking spectacle surely. Investigation as to the causation of leprosy under such circumstances was not a promising outlook. The majority of the inmates belong to the poorer classes of the native or mixed races, and are unable to speak English. In some cases the destructive disease had invaded the larynx, and they could only converse in a whisper. It was as painful to hear as to look at them. I must add that a new and much more spacious and suitable hospital, substantially built of stone, has been erected and is now used for the accommodation of fifty patients. Here I found a better state of things. Another building of like character is in course of erection; so it is evident that the authorities, while apathetic as to the causation of leprosy, have begun to realise the importance of doing what they can to render the condition of these helpless patients as tolerable as possible.

I shall make no attempt to describe the state of the sufferers. I have seen more repulsive cases in lazarettos in other countries, and have seen them both under more favourable and under less favourable conditions. I am of opinion that the lepers and lunatics should be removed to separate quarters, and this barren island should be used exclusively for convicts. Leprosy and lunacy are not criminal, though the former is often caused by the criminal conduct of those responsible for vaccination and for insanitary neglect, and the latter by the temptations of the dram shops, where the vilest and most health - destroying liquors are regularly dispensed. The sufferings of these unfortunate people are sufficiently severe without their being compelled to associate and spend their unhappy lives with convicts. Notwithstanding these difficulties, I was able to hold a brief converse with about fourteen of the inmates who were well enough, amidst their complicated maladies, to understand and reply to a few simple questions. One of the three leper cooks of the establishment kindly acted as my conductor, and pointed out to me those who could speak English. Several were at work as shoemakers and tailors, but the rest had no employment—and, I was informed, did not want any— to relieve the terrible monotony of their painful existence. Some of the inmates were suffering acutely, and needed tender nursing and such devotion as the Moravian Brothers and Dominican Sisters bestow upon lepers in other hospitals. Several of the patients make pets of a harmless snake, a variety of python common to the island, which they keep in cages near their beds.

After I had been introduced by my conductor, and had exchanged salutations with a few words of inquiry, my interrogatories were as follows :—Where were you born? How long have you been a leper? When did you come to Robben Island? Have you had the smallpox? Have you been vaccinated? How long after vaccination did the leprosy appear?

The cook, Christian Choutsee, a native of Cape Town, said he had been a leper four years, and the leprosy broke out "two years after the doctor stuck me in the arms." The answers to the last question were "two years," "three years," "a few years," "two or three years," "after the second vaccination." "Was vaccinated in 1879; leprosy appeared in 1883." "Vaccinated three times, last vaccination during small-pox epidemic in 1878; leprosy attacked me in 1887." "Vaccinated twice, first when twenty years of age. Leprosy appeared between first and second vaccination." "Vaccinated during small-pox epidemic of 1878. Leprosy broke out on me about a year after." "Vaccinated when a boy of between eight and nine years of age; have been a leper fourteen years; present age, twenty-six."

After going through the several male wards, I took an opportunity of making calls upon several persons, including the clergyman, the superintendent of the male wards, and other officials. No one seemed to doubt that leprosy was spread by vaccination. The superintendent of the dispensary, who requested me not to publish his name, gave me particulars of the case of Augustus Lewis, of Cape Colony, who died of leprosy at Robben Island, the disease having been induced by vaccination. I had now been pursuing my inquiries several hours, and as the female leper ward was about a mile distant, and approached only by a rough, stony track, I was obliged, in order to keep my appointment with Dr. Impey, to forego my intended inspection of this department.

Dr. Impey is deeply interested in the pathological side of the leprosy question, and his position as superintendent of the largest leper institution in Africa affords him ample opportunity of pursuing his investigations. He has practised twelve years in South Africa as a District surgeon and Physician, and apart from his clinical experience gained through observations, and the medical care of the population of the island, he has found time to study the literature of the subject. He regards Dr. John D. Hillis’s "Leprosy in British Guiana" as the most valuable and important work he has read. I called his attention to the cases of invaccinated leprosy cited by Dr. Hillis in the volume referred to, and he expressed no surprise at this, having come to a similar conclusion through his own personal researches in different parts of the Colony. Dr. Impey informed me that after careful investigation he had clearly traced to vaccination four out of twenty-eight cases of leprosy, which he had examined in the female ward. One of these still shows leprous discolourations at the point of vaccine inoculation, the disease having exhibited itself two years after vaccination. Dr. Impey will continue his investigations as to the causation of leprosy amongst the remainder of the patients; a procedure, let me observe, almost unknown at similar institutions. It is needless to say that the report of these investigations will be awaited with much interest. Although a believer in the protective value of vaccination as a mitigator of small-pox, Dr. Impey has met with so many cases of invaccinated syphilis and leprosy that he has felt it his duty in his reports, extending over a period of eleven years, to point out the mischief already perpetrated by this mistaken procedure; and he has called upon the Government to legislate for the immediate and total suppression of arm-to-arm vaccination. Dr. Impey considers that leprosy is contagious by actual inoculation, cases of which had occurred at Robben Island, and that to a certain limited extent it is hereditary.