INTERNATIONAL ,1OU R NAL ()F Ln.i'R()til'^ Volume 61, Number 4

I'rinted in the U.S.A.

INTERNATIONAL JOURNAL OF LEPROSYand Other Mycobacterial Diseases

OFFICIAL ORGAN OF THE INTERNATIONAL LEPROSY ASSOCIATION

EDITORIAL OFFICE

Gillis W. Long Hansen's Disease Centerat Louisiana State University

Baton Rouge, Louisiana 70894, U.S.A.

VOLUME 61, NUMBER 4^

DECEMBER 1993

EDITORIAL

Editorial opinions expressed are those of the it riters.

A Singular Obsession: New Brunswick's Leprosy Doctor

In leprosy's long history, the second halfof the 19th century was a significant turningpoint marked by the emergence of a distinctgroup of specialists called leprologists.Carving out a distinctive professional nichefor themselves, they launched their first In-ternational Leprosy Congress in 1897 andbegan publishing their own multilingualjournal, Lepra, 2 years later. This surge ofinterest in leprosy was closely linked to twofactors. First, G.H. Armauer Hansen's iden-tification of the rod-shaped leprosy bacillusin 1873 propclled the disease to the fore-front of bacteriological inquiry and publicconcern. Secondly, as the allcged conta-giousness of leprosy gaincd notoriety awidespread leprophobia hardened into gov-ernment policies mandating specifically de-signed leprosy colonies and the compulsorysegregation of persons with the disease.

Numbered among the exclusive cadre oflcprologists was Dr. Alfred C. Smith, med-ical superintendent of the Tracadie lazaret-to, located in a remote village in northeast-ern New Brunswick, Canada (Fig. 1). Theprice of Smith's physical isolation from themajor medicai centers of the 19th centurywas ultimately undeserved neglect. How-ever, the private papers of this little knownphysician reveal that he counted among hiscolleagues the leading dermatologists and

leprologists of his time, including Drs. Jon-athan Hutchinson, James White, IsadoreDyer, Albert Ashmead, and George Pernet,editor of Lepra. Some of these medicai lu-minaries even paid Smith the complimentof making a pilgrimage to Tracadie, such asDr. James E. Graham, one-time Vice-Pres-ident of the American Dermatological As-sociation; George Fox, a leading Americandermatologist; the legendary Dr. WilliamOsler, and Dr. Henry Stelwagon, the re-nowned American author of A Treatise onDiseases of the Skin. Their visits were onlypartially motivated by professional curios-ity. They also wanted to make the acquain-tance of the remarkable doctor who hadtransformed the Tracadie lazaretto finto amodel institution.

Little is known about the formativo yearsof this original and unconventional physi-cian. Alfred Smith was born in 1841 in Te-tagouche, near Bathurst, New Brunswick,the son of James Smith, one-time grammarschool teacher, school inspector and mer-chant, and Susanna M. Dunn. By 1858,however, Alfred Smith fastened his sightson a medicai career. At the time it was cus-tomary for a student to spend 1 or 2 yearsunder the tutelage of a preceptor before un-dertaking formal medicai school education.Dr. James Nicholson, the first resident phy-

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620^ International lournal^Leprosj,^ 1993

FIG. 1. Map of the Province of New Brunswick, Canada, c. 1915. This map shows the coastal village ofTracadie in Gloucester County facing the Gulf of St. Lawrence (Provincial Archives of New Brunswick,203 c. 1915).

sician at the Tracadie lazaretto, acted asSmith's preceptor. No more than 7 yearsseparated pupil and tutor. Nevertheless,Nicholson obviously had a profound influ-ence on the young Smith, especially in de-termining his choice of leprosy as a spe-cialty. In the fali of 1862, Smith headed forMassachusetts Medical College (later Har-vard Medical School) in Boston, Massachu-setts, U.S.A, which at the time was sweptup in abolitionist fervor. Here he receivedhis medical degree in March 1864» Re-

Archives, Boston Medical Library— Harvard Med-ical Library, AA 17.5, vol. 1 "Graduates with theirTheses 1856-1864."

grettably, no letters survive detailing histraining in Boston, but it is clear that he wasexposed to the teachings of Drs. HenryBowditch, Henry J. Bigelow and OliverWendell Holmes. It was, however, Dr. JamesWhite, then only a part-time lecturer on skindiseases at the college, who had a lastingimpact on Smith.

Oddly enough, Smith never pursued post-graduate studies in Paris, Berlin or even Vi-enna, despite the fact that these were thewell-traveled routes to medical prestige. In-stead, he returned to New Brunswick in 1865to become resident physician at the Tra-cadie lazaretto when the post was left vacantby Nicholson's death. The institution was

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621

little more than a rustic and rambling one-and-a-half-storey frame structure. With asteep-pitched roof and scattered outbuild-ings, it had an almost medieval appearance.Three years later, Smith was dismissed, thecasualty of a money-saving measure. By the1870s he had relocated as a family physicianin Newcastle, New Brunswick. But he re-fused to settle into a comfortable routine,and interrupted his private practice in 1877to undertake postgraduate work at New YorkUniversity School of Medicine. Here he at-tended winter and spring lecture sessionsand expanded his clinical skill at the Beije-vue Hospital and Charity Hospital onBlackwell's Island, where many of the pa-tients were treated for contagious disor-ders. 2 Subsequently, in 1884, he movedtemporarily to Toronto, Ontario, Canada,where he enrolled in a full complement ofcourses, including midwifery, physiology,chemistry and botany, at the Medical Fac-ulty of Victoria University.'

Judging from old photographs, Dr. Smithwas a striking personality (Fig. 2). Hisslightly gaunt face, encircled by woolly mut-ton chops, and his piercing dark eyes pro-jected a commanding presence. The initialimpression he left was an almost antisocialaloofness. He seemed to revel in defyingconventions and conformity. In fact, at timesthe Tracadie leprosy doctor could be crustyand opinionated, and his papers are pep-pered with such marginalia as "trash,""humbug," and "Thank God, I don't knowGerman." And yet he had redeeming qual-ities, most notably his generosity and com-passion. He refrained from intimidating hisleprosy patients with scientific terminologyand treated them with a paternal solicitude.

Nevertheless, to the townspeople of Tra-cadie, this bookish, solitary figure was anenigma. His eccentricities disconcertedthem, especially his eclectic religious views-a product of his first-hand brush with Uni-tarianism at Harvard—which people mis-construed as atheism. Smith also emitted a

' Van B. Afes (Archivist of the New York UniversityMedical Center) to author, 9 July 1984. Sce also 77wAnimal :1 nnouncenrent for the Session 1877-78 (Uni-versity of the City of New York Medical Department).

' Archives, Victoria University, "Schedule of Can-didates for Examination at Medical Board," 1884.

Fio. 2. Dr. AlfrcdC. Smith (1841-1909)asayoungphysician (Centre de Documentation de la Société His-torique Nicolas-Dcnys, A17 #15).

fearful "all knowingness" which gave riseto the rumor that he tapped the telegraphlines and eavesdropped "so he could amazepeople with his knowledge of their privateaffairs." 4 He was also a secretive person.Privacy, in fact, became a personal fixation;while living in Newcastle, he even con-structed a high fence to shield his move-ments between his Nome and adjacent med-icai office. Although seeming remote andscholarly, Smith did have his moments ofwhimsy. When the Harvard Medical Schoolwrote enquiring in 1904 as to his where-abouts, he puckishly stroked out the words

W. Brenton, .tfedicine in Neo' Brunswick (Monc-ton: 1974) 238.

6"^ International fournal ei Leprosy^ 1993

FIG. 3. The second Tracadie lazaretto, c. 1887 (the first was built ia 1849 and burned in 1852) with its manymakeshift extensions shortly before the completed construction of the new one in 1896. The unpainted andrambling frame structure was described ia the mid-1880s as "old, cold, and a pile of decaying wood" (ProvincialArchives of New Brunswick, P20-277).

"Death [Place]," and wrote, "Feels verymuch alive today."5 His sense of humor,typical of medical students of every age,tended to be macabre. According to localfolklore, hc was not above placing a skullon a neighbor's doorstep. His stove, it isalleged, stood on a tombstonc and the upperroom of bis office was modeled on the in-terior of a hearse. Notwithstanding such id-iosyncrasies, Smith was very much the em-bodiment of the scientifically inclined,inquisitive Victorian. He harnessed this en-thusiasm in several hobbies. He was an avidphotographer and a keen devotee of naturalhistory. He even dabbled in taxidermy andarcheology.

Despite these leisure-time activitics, lep-rosy was the all-consuming focus of Smith'scareer. He made no secret of bis "Iong feltdesire to throw myse/f wholly into the studyof leprosy" and to make the disease "thespecial study" of his life.6 Smith's privatepapers vividly reveal the completencss and

Mary Van Winkle to L. Stanley-Blackwell, 22 May1986. This information was extracted from the Bio-graphical File on Harvard Medical School Graduates,compiled c. 1905.

" Le Centre de Documentation de la Société Histo-rique de Nicolas-Denys, Shippagan, N. B. [henceforthCD-SHND] Box 105-1, File 1; Smith to "Dear Sir" 24Sept 1890; also Smith to Minister of Agriculture, 23May 1889.

totality of his dedication to the care andtreatment ofhis leprosy patients. He eagerlycollected books, articles, manuais and news-paper clippings on the disease, amassingwhat he claimed to be the most completelibrary in Canada of medicai literature onleprosy. To special ize in leprosy had a mag-netic appeal to Smith. On occasion, he fan-tasized about inoculating himself with thebacillus of one of his patients, passionatelyconfessing "I have long thought over thematter, and the more I think about it thebetter I like the idea."7 The specialty, whicheventually drove away his regular clients,robbing him of his private practice and con-lining him to the laboratory and the leprosywards, apparently satisfied the decper re-cesses of bis character. In fact, this singularobsession, which was very much on thefringe of medicai science, shaped the wholetexture of his life and career.

was Smith's interest in leprosy whichfueled his ambition to become full-timephysician at the Tracadic lazaretto (Fig. 3).In 1880, he was appointed "Inspecting Phy-sician" and "Medical Advisor" to that in-stitution but, as late as 1889, a more per-manent position still eluded him. That year,Smith vigorously lobbied the Canadian

' CD-SHND, album 105-7, 56; undated clipping"May become a Leper."

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government to enlarge his professional du-ties so that he could give his "whole timeand stucfy to the general superintendence ofthis discase in Canada. " 8 Pointedly, he re-minded officials that leprosy had alrcadysecured a foothold in northern New Bruns-wick and was making inroads in Cape Bre-ton, Nova Scotia. The endorsement of Dr.William Osler gave a timely fillip to Smith'scause. Osler urged the government to ap-point a full-time lazaretto superintendent,arguing that "Dr. Smith has been in touchwith physicians on the subject ali over theworld, and has the necessary skill ... I knowof no one more suitable for the positionshould you create

In November 1889, the Canadian gov-ernment conferrcd on Smith the grandiosesounding title of "Inspector of Leprosy forthe Dominion," but the victory was a hol-low one. His remuneration was a pittance;the annual salary of $600 and a trave] al-lowance of $200 were hardly "sufficient forfunily expenses. " 1 O Smith also found hisprofessional aspirations repeatedly thwart-ed by the popular consensus that leprosywas absolutely incurable and inevitably fa-tal. Such conceptions dictated that the laz-aretto should be a "honre" rather than a"hospital." In othcr words, the physician'srole was irrelcvant, for the leprosy patientsrequired only custodiai tare. Smith had towait another 10 years before the Canadiangovernment finally resolved to administerthe Tracadie leprosy hospital on a more sci-entific basis and elevated him to the rankof "Medical Superintendent." It was a sig-nificant development, denoting official rec-ognition ofthe leprologist's qualifications asa medica) specialist.

With this promotion, Dr. Smith obtainedthe security and afftrmation he had alwayscraved. His daily workplace was the newlyconstructed Tracadie lazaretto (Fig. 4), amassive three-storey stone structure with animposing cruciform shape, mansard roofandverandas. A far cry from its rustic prede-cessor, the new structure, completed in 1896,

" Nacional Archives of Canada [henccforth NAC]RG 17, A.I.1, vol. 623; Smith to Lowe, 17 Sept 1889.

Ibid., vol. 624; Osler to Minister of Agriculture, 22Sept 1889.

'" Ibid., vol. 685; Smith to Lowe, 8 May 1891.

FIG. 4. The Tracadie Lazaretto, c. 1900. The Icftwing housed the Sisters' convent and the right wingwith its parcial verandahs served as wards for the lep-rosy patients (the males on the first storey, the femalessegregated on the second). Behind the white picket fenceto the right was the patients' garden where they couldgrow Ilowers and vegetables. Dr. Smith's office was tothe left of the main entrance and the pharmacy to theright. Extending to the rear was a hospital wing (Pro-vincial Archives of New Brunswick, P6-43).

contained roomy living quarters for the pa-tients and a sizable staff of nursing sistersbelonging to the Order of the Religious Hos-pitallers of St. Joseph (Fig. 5)." For the firsttime, Smith enjoyed having a permanentoffice on the hospital premises. Henceforth,his personal and professional existence be-came virtually coterminous with the laza-retto in Tracadie. Even his residente, wherehe lived with his wife and three children,was not beyond the reach ofthe long shadowof the lazaretto. Its physical proximity wasfurther reinforced in 1906 when Smith in-stalled two telephones in his house, includ-ing one in his bedroom, so that he mighthave "daily and nightly connection" withthe lazaretto.''

Smith's duties at the leprosy hospital wereas varied as they were arduous. He visitedthe wards daily, frequently performed sur-gical and dental procedures, and spent a

" The new stone lazaretto was designcd to accom-modate about 50 patients, but it never housed morethan about half that number at any one time. From1844 to 1965, approximately 325 people diagnosedwith Ieprosy were institutionalized in New Brunswick,first on Sheldrake Island (1844-1849) and then at Tra-cadie. The last two cases from New Brunswick entercdthe Tracadie lazaretto in 1937. During the last 28 ycarsof its existente, this institution received only a trickleof patients, coming from such varied origins as China,Malta, Russia and Lithuania. Shortly before the laza-retto's closure in 1965, the last patient was rclocatedin a nursing home where shc dicd in 1969.

'' NAC, RG 29, vol. 5, File 937015 1/2 pt. 5; Smithto Montizambert, 11 October 1906.

624^ International Journal of Leprosv^ 1993

FIG. 5. The Rcligious Hospitallcrs of Saint Joseph Sisters and their patients at the Tracadie Lazaretto, c.1875 (Provincial Archives of New Brunswick, P67-3).

portion of each day engaged in laboratoryresearch. He was also entrusted with suchmatters as diet, hygiene and discipline.Within his jurisdiction fell the preparationofannual government reports, maintenanceof registers of admissions, ward visits andprescriptions, compilation of genealogicaldata on leprosy families, correspondencewith the families of patients and the fumi-gation of railway cars used to transport lep-rosy sufferers. Sm ith's duties often took himoutside the lazaretto wards on "tours of in-spection," which he facetiously dubbed lep-rosy "hunting."" Armed with a "Hawk-eye" camera and notebook, he periodicallycrisscrossed northern New Brunswick, vis-iting various households and local lobstercanneries and fish-packing plants. On thesetrips, he would track down and diagnoseleprosy "suspects" and would employ therequisite mixture of compassion and coer-cion to secure their admission to the laza-retto. The formula he devised was swiftlyefficient: "When I declare an individual lep-rous, his nearest friends avoid him; he isrefused employment, and he soon finds aresting place in the home provided for suchunfortunates."14 For those people falsely

Historical Collections, Library of the College ofPhysicians, Philadelphia; Smith to Ashmead, 18 Aug1897.

Canada Sessional Papers, vol. 6, 1900, appendix11; Report on the Lazaretto, Tracadie, 31 Oct 1899,p. 91.

tarred as having leprosy by public opinion,he issued the much prized "Certificates ofFreedom From Leprosy." Visitations anddiagnostic examinations were sometimesfraught with hazards. Smith reported thathe had "guns fired near me in a menacingmanner . . . been threatened with physicalviolence, and . sat listening by the hourto abusive language."15 In 1889, he traveledfurther afield to Cape Breton to investigaterumored "outbreaks of leprosy."'" In thespring of 1891, he was despatched to Vic-toria, British Columbia, where he diagnosedleprosy in five patients and authorized theirremova! to D'Arcy Island, Canada's PacificCoast lazaretto. In 1897 and 1907, he jour-neyed to Winnipeg, to examine suspectedcases of leprosy among Icelandic immi-grants.

The widely read Smith maintained dis-tinctive views about the etiology and treat-ment of leprosy. Throughout the 1880s, hewas neither a dogmatic contagionist nor arigid hereditarian. He mulled over the di-verse arguments for innate susceptibility,environmental causation and inoculation,willing to test the soundness of ai! options.It was not until 1904 that his opinions fi-nally crystallized. By then, he was unequiv-

NAC, RG 29, vol. 300; Smith to Montizambert,8 Jan 1906.

CD-SHND, Box 105-1, File I; Smith to Ministerof Agrieulture, 23 May 1889.

61, 4^ Editorial^ 625

ocally convinced of leprosy's contagiouscharacter.

One of Smith's most striking trademarkswas his diagnostic caution. For him, diag-nosis was an act of gravity, while misdiag-nosis was "a terrible and inexcusable er-ror."7 Smith knew only too well that lupus,psoriasis and syphilis could often pass de-ceptively for leprosy. The medicai regimenwhich Smith prescribed for his patients wasalso marked by prudence. Although con-versant with the popular antileprotics of theday, such as gurjun ou, Carrasquilla's serumand Leprolin, Smith did not condonc ex-cessive experimentation or lcap at eachpassing fad. In his supportive and curativetherapies, he preferred to err on the side ofmoderation, often extolling the palliativebencfits of sound hygiene and nutritious diet.These principies, he claimcd, not only ame-liorated the lcprosy sufferers' moral andphysical well-being, but also extended thcirlifc expectancy. Smith did not closc his mindcompletely to more radical treatments. AU-ter monitoring its progress for 4 years, hefinally decided to test the efficacy ofichthyolon some of his own patients. He also ex-perimented briefly with a decoction madcfrom the leaves, twigs and seeds of the tua-tua plant, as well as a eucalyptus compound;both were employed at the leprosy colonyin Hawaii. Chaulmoogra ou, however, wasthe keystonc of Smith's medicai regimen atthe Tracadic lazaretto. In 1884, he intro-duced the ou l to some of his patients butwith negative results. In 1902, he resumedits use both orally and externally, some-times in combination with creolin andstrychnine. To lessen its unpleasant tasteand odor, Smith frequently diluted the dos-ages with syrup of wild cherry bark. Al-though few patients, even the less-advancedcases, could tolcrate its extended use, Smithwaxed enthusiastically about chaulmoograoil's healing properties. Unlike many of hisleprologist contemporaries, he was opti-mistic about the potential curability of lep-rosy. In fact, he did not consider the ideaof a "specific" visionary. Although his ther-apeutic optimism faded by the turn of the

Canada Sessional Papers, vol. 6, 1900, appendix11; Report on the Lazaretto, Tracadie, 31 Oct 1899,91.

century, Smith's belief in the effectivencssofchaulmoogra oil was unwavering. He gavethe natural cure his unequivocal endorse-ment, claiming in 1907: "I believe thatchaulmoogra ou, in combination, will cureleprosy if begun before serious inroads havebeen made on the constitution, and i f main-tained long enough."'8 Unlike many of hiscolleagues, Smith also believed in "spon-tancous recovery." In at least five instances,the Tracadic doctor had witnessed full re-coveries or extended remissions. Thesemedicai conundrums served to remind himof leprosy's inconsistencies and the folly ofdogmatism.

Only on one point did Smith prove him-self inflexible. He regarded compulsory seg-regation an essential component in thetreatment and containment of leprosy. Dis-missing a relaxed approach to the diseaseas impractical idealism, he battled for morestringent legislation for the apprehension,dctention and medicai supervision of lep-rosy patients. From his perspective, leprosywas both a medicai and a managementproblem requiring compulsion tempered bycompassion.

Owing to the fact that Smith committedso few of bis ideas about lcprosy to paper,it is difficult to determine what medicai au-thors or leprologists moulded his opinions.Nevertheless, although compelled to pursuehis careci- in the backwaters of northern NewBrunswick, he clearly did not stagnate pro-fessionally or intellectually. Throughout hiscareer, he dcmonstrated an eagerness to ex-pand and updatc his knowledge. He wasparticularly intcnt on honing his researchtcchniques. The fact that he never receivedany formal laboratory training proved ahandicap in bis technical development. Oc-casionally, he mused about going to Har-vard Medical School or the University ofMichigan for a more intensive introductionto bacteriology. The main stumbling blockto these plans was an unsupportive Cana-dian government. Smith's request for leaveto study at McGill University, for example,was greeted with an official remonstranceabout his overriding professional commit-

Ibid., vol. 7, 1908, appendix 12; Smith to Ministerof Agriculture, 31 March 1907, 16.

626^ Intc'rnational.Iournal of Leprosy^ 1993

ments to the lazaretto. When he was invitedto attend thc 1897 Leprosy Congress as adelegate, the government declined to sub-sidize his trip to Berlin. Aggrieved by thegovernment's short-sighled stingincss,Smith retorted "Leprologists the world overexpect me to add my quota to the sum totalof knowlcdge on the subject ... and I findmyself seriously handicapped for want ofscientific instruments."''

Thwarted in his own forays finto labora-tory research, Smith was not shy about so-liciting the expertise ofothers. In 1897, JohnT. Bowen, an expert histopathologist andassistant physician in thc outpaticnt dc-partment for skin diseases at MassachusettsGeneral Hospital, coachcd Smith by letter,advising him about procedures for stainingand mounting slides, removing tubercles andemploying a cutaneous punch. By that date,Smith considered the microscope an indis-pensable diagnostic tool; in fact, he regardedbacteriological confirmation a requisite pre-condition to institutional commitment. Inthis work, he was assisted by both Drs. Bow-en and James White, to whom he mailedoff small packages of tissue and smears foranalysis. Smith also correspondcd on a con-sultative basis with Prince Morrow, whomhe visited in New York in the fali of 1890,learning first hand of the latter's recent re-search expedition to Hawaii.

Such contacts must have done much tomitigate Smith's lonely existence and satisfyhis appetite for collegial interaction. Occa-sionally, however, his correspondencebrought unwelcome notoriety and embar-rassment. In January 1904, for example,Smith found himself quoted in the LondonTimes by the celebrated Jonathan' Hutch-inson. The Tracadie physician was redfacedthat one of his letters had been marshalledas evidence to support Hutchinson's fatu-ous theories about leprosy and fish-eating.Smith's letters with the Louisiana leprolo-gist Dr. Isadore Dyer also prompted con-flict. Together the two men explored thepossibility ofa relationship between leprosyin Louisiana and that in the Maritime Provinces of Canada, although Smith balked atDyer's attcmpts to tie the genesis of leprosy

NAC, RG 29, vol. 5, File 937015 1/2 pt. 2; Smithto Scarth, 25 May 1897.

in Louisiana to thc deportation of the Aca-dians in the 1750s. Much more compro-mising wcre Smith's exchanges with Dr. Al-bert Ashmead. In all innocence, Dr. Smithhelped fuel Ashmcad's odious theories aboutleprosy and racial regression, having oncecommented that the leprosy patients "inNew Brunswick are degenerated French." 20

Again, he found his narre associated witha crude theory with which he really had littlesympathy.

It should be notcd that in 1901 the Ca-nadian government finally outfittcd Smithwith a fully equipped laboratory. But thisconcession carne too late. By then, glauco-ma seriously interfered with his rescarch. Inretrospect, it is difficult to gauge the signif-icance of Smith's rescarch. It is regrettablethat he published nothing about his labo-ratory work. In his private papers, however,he mentioned the use of microphotographyand detailed complex staining procedures.An American bacteriologist once praisedhim: "It would be hard to beat your spec-imens." 2 '

Smith, however, never became as emi-nent as the specialists with whom he cor-responded. There is no easy explanation forhis unrealized potential. Undoubtedly,Smith's zeal was drained by a callous gov-ernment, the stubborn incurability of hispatients, and the unrelieved tedium of hisjob. I11 hcalth also took its physical and pro-fessional toll. Glaucoma frustrated his re-search, and during the wintcr of 1907-1908,he was virtually paralyzed by rheumatismwhich flared up after he had completed thechilling nine-hour task of fumigating an un-heated railway car. The following year wasmarrcd by insomnia, mental exhaustion anda series of strokes. Smith died on 12 March1909. Interestingly enough, his passing at-tracted the attention of the New York Times,which ran the sensational headlinc, "Experton Leprosy Dies. Physician to New Bruns-wick's Leper Colony Recently announced acure." 22 Even though his death went unack-

'° Albcrt Ashmead, "Introduction of Leprosy fintoNova Scotia and the Province of New Brunswick, Mic-macs lmmune," The Jo u•nal of the American ,Medicalassociation, XXVI, 1 Feb 1896, 203, 207.

' ' CD-SHND, Box 105-5, File 11; Cowie to Smith,n.d. [e. 19011.

22 New York Times, 21 March 1909.

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nowledged in the Canada Lancei and 7'heCanadian Practitioner, notices did appearin the Boston Medical and Surgical Journaland the Journal qf the /inierican MedicalAssociation." These were, however, littlemore than cursory references. It was frombis "inconsolable" leprosy patients thatSmith's death elicited the most poignant re-sponse. h is recorded that they bolted fromthe hospital wards, scattered across thenearby field, and headed for Dr. Smith'sresidence (Fig. 6), where they were greetedby his widow. Sensing their grief, she "ac-corded them the privilege of entering theroom where bis remains were laid out."24

Clearly, Smith's most tangible memorialwas the Tracadie leprosy hospital. Underbis medicai superintendence, the lazarettowas both modernized and humanized. Un-wavering in bis vision that the lazarettoshould be more than a detention center ora religious hospice, Smith ensured that itfunctioned as both a "hospital" and a"home." The Tracadie lazaretto also epito-

" Journal Olhe ..11)1CriCan Medical Association. vol.LII (3 April 1909)110. 14, p. 1131; Basun! Medical and.S'urgical Journal, vol. CLX (18 March 1909) p. 356.A more detailed aecount of Dr. Smith's remarkablecareer can be found in Laurie C. C. Stanley, "Leprosyin New Brunswick 1844-1910: A Reconsideration"(unpublished Ph.D. dissertation, Queen's University,1989).

" Archives of the Religious Hospitallers of Si. Jo-seph, Tracadie„-Imudes 1909, 185.

FIG. 6. Dr. Smith's house and office in Tracadiesometime after his death (Private Collection).

mized the application of moderation andpractical scientific principies. As such, it be-came the highly acclaimed exemplar for lep-rosy institutions around the world. This in-ternational reputation was due in no smallpart to the lazaretto's caring and capableMedical Superintendent. For this reasonalone, Dr. A. C. Smith deserves to be re-membered more widely than he is."

— Laurie C. C. Stanley-Blackwell, Ph. D.zissistant professorDepartment of HistorySi. FranCiS Xavier UniversityAntigonish, Nova ScotiaCanada B2G 1CO

" Today visitors to Tracadie can see arti facts relate('to the history of this institution ai the Musée Nisto-rique de Tracadie and visit the hospital cemetery.