304 LEPROSY 



time 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. It should also be 

 mentioned that tubercle is a not uncommon complication in 

 leprous subjects, in which case it presents the ordinary characters. 

 It has been found that, a considerable proportion of lepers react 

 to tuberculin like tubercular patients. This result has been 

 variously interpreted, some considering that tuberculosis is also 

 present in such cases, whilst others maintain that the reaction 

 may be given in the absence of tubercle. If, as is probable, the 

 latter is the case, the result most likely depends on the close 

 relationship of the organisms of the two diseases ; it by no means 

 proves their identity. Another curious fact is that the Wasser- 

 mann reaction (p. 131) may be given by the serum of leprous 

 patients (in about 50 per cent., according to some observers) ; 

 this would seem to be quite independent of the concurrent 

 presence of syphilis, but it is not possible at present to give an 

 explanation of the phenomenon. 



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, 



