Since the establishment of the Cheung Mai mission in 1867 the missionaries have made the care of the sick a part of their regular work. Dr. Vrooman was the first missionary physician sent to Cheung Mai; he was compelled, on account of his health, to leave there in 1873, having remained only about two years. Dr. Vrooman’s successor arrived in Cheung Mai in the spring of 1875. During the six months ending Sept. 30, 1875, about six hundred patients received treatment of the foreign doctor. The work has increased steadily since that time; in the year ending Sept. 30, 1882, thirteen thousand persons received treatment. This increase in seven years from about one thousand to thirteen thousand a year indicates that the work of the medical missionary supplies a demand. Because of having no hospital accommodations, the work has been chiefly dispensary work, while as many as could be personally attended have been visited at their homes. Notwithstanding this large increase in the number of patients treated, the results of the medical work have not been very gratifying. The difficulties with which one has to struggle in dispensary work or house visitation are so great as to render any effort almost devoid of satisfactory results from a professional point of view; and, obviously, the conditions which interfere with the medical work will also interfere with the missionary work; in fact, what are molehills in the former become mountains in the latter. The houses of the Laos are located and built in violation of all hygienic considerations, and in addition to the counteracting influences arising from the imperfect sanitary surroundings, the foreign physician has to contend against persistent meddlesome interference with his directions; and in this contention he wages a losing warfare, for he has arrayed against him that influence which is so potent everywhere――namely, the prestige of ancient superstitions sanctioned by ignorance and custom. In the treatment of diseases the skill of the most competent physician is of no avail without the faithful and skillful execution of his orders, which can be accomplished alone by an intelligent and sympathizing nurse――I might rather say, a trained nurse. The foreign physician is usually sent for as a last resort, and is simply expected to perform a miracle; and unless he in a measure satisfies the wildest requirements he is pronounced a failure, and his presence is considered as rather an intrusion and a source of mischief; for he forbids ceremonies which are supposed to be essential to the welfare of the household, a neglect of which may occasion both immediate and remote disaster. Although spirit-worship and other religious observances are of paramount importance in their homes, they willingly neglect them when treated upon our own premises.