190 PHYSIC 



down. and perishing dermal and sub-dermal tissues, and in 

 some cases the regurgitant accumulations in, and the 

 ultimate so-called pseudo-hypertrophy of, the involved 

 nerve trunks. 



Leprosy may, therefore, be denned as a disease primarily 

 initiated by purely mechanical causes, evolved by the com- 

 bination of these with bacterial influences, and closed by 

 the devitalisation and disintegration of the tissues in- 

 volved, ending, it may be, spontaneously in sorely maimed 

 recovery, but generally in exhaustion and death consti- 

 tuting altogether one of the most tragic and melancholy 

 morbid spectacles to be met with in the whole range of 

 human disease. 



As thus defined, its evolution proceeds somewhat on the 

 following lines, according to the geographical locale and 

 climatic conditions in which it may happen to arise being 

 due, as we contend, to initial arrest of cuticular desquama- 

 tion and retained dermal or peripheral excretional products, 

 leprosy is evolved by accumulation of this epidermal debris 

 on the functionally active and proliferating dermal tissues, 

 where it undergoes a process of gradual thickening by 

 continued accretion and cementing, which effectually pre- 

 vents the process of normal desquamation and bars the 

 exits of the sweat glands, and thus leads to greater and 

 greater upheaval of the involved epidermis, and the 

 damming back of the arrested sweat, with its consequent 

 and compelled regurgitation along the neurilemmar inter- 

 spaces of the implicated peripheral terminal nervature and 

 nerve trunks, with, it may be, induced peri-neuritis and the 

 development of pseudo-hypertrophy of the involved or 

 connected nerve trunks. As this process proceeds, and 

 where sufficient foothold, so to speak, is presented to the 

 lurking lepra bacillus to effect an entrance on the scene, 

 we see commenced the concluding stages of that long 

 drawn-out morbid process and that physiologico-patho- 

 logical conflict between the original and acquired phagocytic 

 agents of the human organism represented by the host of 

 leprosy in all its usually unmitigated hideousness and 

 "long-suffering" endurance. 



During this physiologico-pathological conflict, if the 

 fortunes of war be on the side of the original and against 



