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A PHOTOGRAPHIC STUDY OF LEPROSY: 
. By Oswatp E. DENNEY 
(Chief, Culion Leper Colony, Culion, P. I.) 
FOUR PLATES 
The great variety of typical lesions of leprosy has rendered 
it impracticable completely to illustrate the disease in the aver- 
age textbook; it seemed desirable, therefore, to present a pho- 
tographic study showing the progression of the external lesions. 
The clinical manifestations of leprosy have been so fully 
described by the many students of the disease that discussion 
at length in the present paper is not necessary. The disease 
is generally considered to manifest itself in two distinct types— 
the “nodular” and the “maculo-anesthetic.” A combination of 
symptoms of these two is recognized as the “mixed” type. In 
this study the two principal types only will be considered; the 
mixed type, obviously, may present any composite picture of 
the nodular and maculo-anzsthetic types. 
Since the manner of entrance into the body of the causative 
agent of the disease (Mycobacteriwm lepre, or Bacillus leprz 
Hansen) is unknown, the initial lesion cannot be demonstrated 
with certainty; however, the earliest recognized lesion can be 
illustrated (Plate I, figs. 1 to 9; and Plate II, figs. 10 to 15). 
The progression of the lesions of the nodular type as indicated 
in the above series may be reproduced in practically any part of 
the body. 
The photographable manifestations of uncomplicated maculo- 
anesthetic leprosy are mainly confined to the macules, which 
appear chiefly on the back and face, but which may appear on 
any part of the body; the deformities that result from motor- 
nerve destruction; and the trophic ulcers that result from dis- 
turbed nutrition. The deformities of uncomplicated maculo- 
anesthetic leprosy in the hands are illustrated by Plate II, figs. 
16 and 17; and Plate III, figs. 18 and 19. 
Plate III, fig. 20, illustrates the typical perforating ulcer of 
the foot; this lesion is considered as diagnostic of leprosy by 
the natives in many parts of the world. 
* Received for publication, September 6, 1918. 
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