ON LEPROSY 189 



it is the bounden duty of the profession of medicine to 

 undertake the treatment to satisfy its amour propre, as 

 well as to reclaim from abject misery and hopelessness the 

 unfortunate outcasts of, at the best, a barbarous and 

 melancholy survival of ancient folk-medicine. 



Pursuing the subject of the nervine origin of leprosy 

 a little further, we are brought face to face with examples 

 of undoubted neural circulatory stasis, accumulation of 

 neural substance, lymphoid and plastic, in the lumina of 

 the neurilemmar tubes, and the nerve tubes proper, with 

 regurgitation along them and consequent enlargement, 

 and sometimes varicosity of the implicated nerve trunks, 

 occurrences which have hitherto ranked as nerve hyper- 

 trophy from neuritis and accompanying hyperplasia. At 

 a glance we see that these cases of the disease, and kindred 

 ethers, conform to the formative conditions and evolution- 

 ary requirements necessitated by nervine origin and 

 progress, and that the whole sequence of morbid events 

 constituting their clinical history and progress is deter- 

 mined by nervine conditions, plus, ultimately or later, 

 the addition of bacterial influences, which to some extent 

 modify the later and latest stages of the disease. The 

 bacterial invasion cannot take place unless a suitable local 

 culture medium is provided for the growth and increase 

 of the organisms, and the continued maintenance of their 

 malign brood, and this medium, we hold, is provided in 

 the accumulating and unhygienic neuro-dermal debris ; 

 it follows, therefore, that the absence of this culture 

 medium must be followed by bacterially negative results 

 on every occasion, and that the universal non-supply of 

 these media must inevitably be followed by the non- 

 existence or extinction of the peccant organisms. We 

 must assert, moreover, that the part of the nervous system 

 primarily involved in the leprous process is the systemic, 

 whose excretional exits on its afferent or sensory side are 

 entirely on the skin, where the obstructing influences of 

 external dirt and the accumulation of neuro-dermal im- 

 pedimenta or exuviae ultimately effect the blockage of 

 these exits, with the consequent damming back of the 

 outflowing and outgrowing neural elements, and their 

 piling up, so to speak, amid the wreckage of breaking 



