THE BAHAMA ISLANDS 399 



Leprosy. 



One of the most important diseases which we studied in the Bahamas 

 and which was especially interesting to us on account of its rarity in this 

 country was that of leprosy. This disease is rapidly becoming, and in fact 

 already is, quite prevalent among the Bahama Islands. With the exception 

 of a lazaretto at Nassau, the government has provided no means of isolating or 

 caring for the people suffering with this horrible affliction, and it is for the 

 purpose of bringing this matter to the attention of the authorities that much 

 of the discussion in this chapter has been undertaken. 



Forms of Leprosy. 



There are two chief forms of leprosy, one called the tubercular form, 

 lepra tuberosa or tuberculosa, and the other the anesthetic or maculo-an- 

 esthetic. 



Tubercular Leprosy. — This is characterized by the growth of granulation 

 tissue in a nodular manner or as profuse infiltration of the skin, of mucous 

 membrane with resulting disfigurement. The disease usually starts with the 

 appearance of erythematous patches attended by some fever and followed by 

 small nodular thickenings in the skin especially of the face, backs of the hands 

 and feet, and extensor aspects of the arms and legs. These nodules enlarge 

 and produce great distortion of the surface so that an appearance is given to 

 the face which is described as the leonine facies (Plate LXX). This thicken- 

 ing is chiefly in the cutis of the skin, and the epithelium becomes stretched 

 over the nodules to such an extent that an oozing surface is developed or 

 actual ulceration takes place. The eyes, mucous membranes, mouth, larynx 

 and pharynx are the seats of similar nodular growths. The internal organs, 

 especially the liver, spleen and testicles, may become affected secondarily. The 

 changes in all situations are characterized by a chronic inflammatory condition, 

 accompanied by abundant growths of granulation tissue, in which tissue a large 

 proportion of the cells are rounded or oval in shape and may be of quite a large 

 size showing vacuolation Avith vesicular type of nucleus. These cells are 

 spoken of as "lepra cells." Periarteritis is a common change and very fre- 

 quently the superficial nerves become involved in the nodules and atrophy. The 

 tissue in the leprous lesions is vascular when young, and never shows caseation 

 as in tuberculosis. Lepra cells may contain several nuclei but do not resemble 

 the giant-cells in tuberculosis. 



Anesthefic Leprosy. — The changes here are in the nerves with resulting 



