12 G. H. MONRAD-KROHN. M.-N. Kl. 



The spinal roots, too, have been found the seat of degenerative changes 

 (Lie). Sudakewitsch has found bacilli and degenerative changes also in 

 the Gasserian ganglion and in symphatetic nervf's. This, author (Suda- 

 kewitsch) has also found lepra bacilli and inflammatory changes in the 

 corpuscles of Pacini. Inflammatory changes in the Pacinian bodies had 

 already been found by G. and F. E. Hoggan in 1882, but while these authors 

 believed the Pacinien bodies to be afi'ected by a descending secondary 

 degeneration, Sudakewitsch regarded them as the place of entry, whence 

 the bacilli start their invasion along the nerves. 



The now obsolete views of Zambaco Pasha must finally be mentioned. 

 This author claimed that a series of other diseases (amongst other syringo- 

 myelia, Raynaud's disease, and progressive spinal muscular atrophy) were 

 nothing but attenuated forms of leprosy. Although Zambaco Pasha's views 

 are now generally rejected, they may be quoted as a memento to remind 

 one how close the resemblance can be between syringomyelia and leprosy 

 — and how difficult sometimes the differential diagnosis. 



Finally, it must be mentioned that Colella, Stanziale and Babes claim 

 to have found leprosy bacilli in the cerebrum. This is, however, not at 

 all a frequent finding, whereas according to Stahlberg non-specific degen- 

 erative changes in the brain are fairly frequent both in nodular and ma- 

 culo-anæsthetic cases of leprosy. The degeneration affects both cells and 

 nerve fibres. 



3. Clinical Findings. 



In the preceding chapter the cases have already been divided into 

 three groups: nodular, maculo-anæsthetic and mixed. It has to be pointed 

 out that this classification, though justified, at least in advanced cases, is to 

 some extent arbitrary. Particularly in early cases it may, as Muir and 

 others have pointed out, be difficult to decide to which group the case 

 belongs. Transitions from one form to another are not rare. A systematic 

 neurological examination will disclose nerve lesions in a surprisingly big 

 number of the nodular cases also. 



With this reservation the old classification can still be maintained and 

 will be found useful for practical clinical purposes. 



Clinical evidence seems to point to the possibility of a spontaneous 

 cure of leprosy — or at least a spontaneous arrest in the development of 

 the leprous lesions. When this occurs at an advanced stage, when the 

 nerve changes are firmly established, all or some of the nervous disturb- 

 ances are left as permanent remainders. These cases are spoken of as 

 "secondary anæsthetic forms", when they are the outcome of originally 

 nodular cases. 



