21,3 Gomez et al.: Early Lesions of Leprosy 941 
born in the colony who. at the present writing are unquestionably 
lepers, confirms the findings in the preceding table, in that in 
all of the twenty-four cases lesions of the skin were found 
positive while only thirteen were bacteriologically positive in 
scrapings from the septum of the nose; the other eleven were 
bacteriologically negative in this site. 
Our records show two children (No. 13, A.C. and No. 12, A.M., 
Table 3) who, on former bacteriological examinations, were 
positive only in skin lesions, and now they are positive bacterio- 
logically in the skin and nose. Two other children (G.D. and 
P.I.), showing suspicious lesions in the skin, were repeatedly 
examined bacteriologically with negative results and, after 
an interval of six months, became positive bacteriologically, only 
in the skin so far. 
Bacteriological but not physical examination was made of 
the noses of sixty-one other children, from 1 to 12 years old, 
with negative results. Their skin was also negative bacterio- 
logically and showed lesions; such as flushed skin of the legs 
only, suspicious or characteristic white patches in some of which 
there was a definite reddish tint indicating progressive changes, 
or definite anesthesia either in white patches or in regions of 
the body which show no skin blemishes. 
Considering the above data, one might conclude that the 
early lesion is located in the skin and not in the nose. Our 
results are at variance with the theory of Sticker,(7) who claimed 
that the nose was the site of the initial lesion of leprosy, and 
are in conformity with the results obtained by Brinckerhoff and 
Moore,(1) who concluded that the routine examination of the 
nasal septum and the nasal secretions is not an efficient method 
for the detection of leprosy in its incipient stage. 
THE NATURE OF THE EARLY LESION 
It is natural that in young children it is hard to obtain re- 
liable history as to subjective sensations, and the main reliance 
on manifestations of the disease must be looked for in the sub- 
jective signs in the skin. We have found that the commonest 
manifestation of the disease is the appearance of macular lesions, 
which are whitish patches resembling morphea spots and which 
we refer to here as “macula alba.” 
The macula alba are whitish light fawn in color, level with 
the skin, and have a smooth, nonscaly surface and irregular edges 
of from 1 to 10 centimeters wide. They appear singly and 
gradually increase in size and number, or they may break out in 
