274 LEPROSY 



in leprous subjects there occur febrile attacks, which are followed 

 by a fresh outbreak of nodules, and it would appear that 

 especially at these times multiplication of the bacilli takes place 

 more actively. 



The facts stated with regard to cultivation and inoculation 

 experiments go to distinguish the leprosy bacillus all the more 

 strongly from other organisms. Some have supposed that 

 leprosy is a form of tubercle, or tubercle modified in some way, 

 but for this there appears to us to be no evidence. Both from 

 the pathological and from the bacteriological point of view the 

 diseases are distinct. It should also be mentioned that tubercle 

 is a not uncommon complication in leprous subjects, in which 

 case it presents the ordinary characters. 



The mode by which leprosy is transmitted has been the 

 subject of great controversy, and is one on which authorities still 

 hold opposite opinions. Some consider that it is a hereditary 

 disease, or at least that it is transmitted from a parent to the 

 offspring ; others again that it is transmitted by direct contact. 

 There appears to be no doubt, however, that on the one hand 

 leprous subjects may bear children free from leprosy, and that on 

 the other hand, healthy individuals entering a leprous district may 

 contract the disease, though this rarely occurs. Of the latter 

 occurrence there is the well-known instance of Father Damien, 

 who contracted leprosy after going to the Sandwich Islands. In 

 view of all the facts there can be little doubt that leprosy in 

 certain conditions may be transmitted by direct contact, though 

 its contagiousness is not of a high order. 



Methods of Diagnosis. Film preparations should be made 

 with the discharge from any ulcerated nodule which may be 

 present, or from the scraping of a portion of excised tissue, and 

 should be stained as above described. The presence of large 

 numbers of bacilli situated within the cells and giving the staining 

 reaction of leprosy bacilli, is conclusive. It is more satisfactory, 

 however, to make microscopic sections through a portion of the 

 excised tissue, when the structure of the nodule and the arrange- 

 ment of the bacilli can be readily studied. The points of 

 difference between leprosy and tubercle have already been stated, 

 and in most cases there is really no difficulty in distinguishing 

 the two conditions. 



