21,3 Gomez et al.: Early Lesions of Leprosy IAT 
scrapings from lesions of the skin and the septum of the nose were pore 
for B. lepre. 
V.—E.R. (Table 3, No. 23), Filipino, 12 years old, female. aon in 
Culion. Both parents, now dead, were lepers. No brothers or sisters. 
First lesions that appeared were two whitish areas on the back; later 
such areas became numerous and extensive; then nodules appeared, first 
on both elbows and knees, then on the hands and feet and, later, on the 
ale nasi, chin, and ears (Plate 6, fig. 1). 
Her condition on February 18, 1922, was briefly as follows: Nodules on 
ears, ale nasi, chin, both elbows, and forearms, and nodular masses on 
hands and knees. Infiltrations on cheeks, both forearms, nates, thighs, 
legs, and feet. Extensive white areas on trunk and arms. Legs dry and 
scaly. Inguinal glands on both sides enlarged. Axillary glands not pal- 
pable. There was no falling out of eyebrows. The white areas in parts 
were denuded of hair, but in most cases the hair was normal. 
Thermal and tactile anesthesia on the ulnar region, both sides, and 
on both calves; thermal anezthesia only on both elbows and tendo achillis; 
no thermal or tactile anesthesia on the white areas. 
The nose shows scabs and ulceration on both sides of the septum and on 
the left ala nasi; there was bleeding on detaching the scabs. 
The bacteriological findings were positive for the white areas, nodules, 
and the septum of the nose. 
VI—F.S. (Table 3, No. 24), Filipino, 18 years old, male. Born in 
Culion. Both parents, now dead, were lepers. No brothers or sisters. 
The disease commenced several years ago with anesthesia on the elbows 
and on the knees. Later there was infiltration on both ears, and then 
the appearance of nodules. Two months ago numerous white areas 
appeared on the trunk (Plate 6, fig. 2). There has been no prodromal 
chill and fever; nor were there any paresthetic symptoms. — 
At present (February, 1922) there are typical nodules on the ears 
and on the right side of the ale of the nose. There is infiltration on both 
cheeks. The femoral glands are greatly enlarged, and the inguinal and 
axillary glands are palpable. The small finger of the right hand is 
thickened but is not anesthetic to touch. Both ulnar nerves are slightly 
thickened, but there is no tactile anesthesia on the forearms. There is 
thermal and tactile anesthesia on the thighs and in the neighborhood of 
the knees. The trunk and chest show white nonanzsthetic areas. The 
skin on both arms and legs is dry and scurfy. 
The bacteriological examination was positive of smears made from 
the white areas, nodules, the juice aspirated from the left inguinal gland, 
and the septum of the nose. 
The type of suspicious or definite leprosy lesions occurring 
among brothers and sisters of different ages is indicative of the 
period of development of leprosy and suggests that the white 
patches in the skin of children are either leprous spots or pre- 
cursors of definite leper manifestations. The following notes 
on children of the same parents serve to verify this statement: 
1—“I.” E., 11 years old, female, was previously suspicious, showing a 
thickening in ‘the region of the Darwinian tubercle of the ear and a 
whitish area on the left side of the face which was slightly reddish; 
