35 8 Leprosy 



of tissue freshly excised from a lepra nodule were introduced 

 beneath his skin and the man was kept under observation. 

 In the course of some months typical lesions began to 

 develop at the points of inoculation and spread gradually, 

 ending in general leprosy in about five years. 



Sticker* is of the opinion that the primary infection 

 in lepra takes place through the nose, supporting his opinion 

 by observations upon 153 accurately studied cases, in 

 which 



1. The nasal lesion is the only one constant in both the 

 nodular and anesthetic forms of the disease. 



2. The nasal lesion is peculiar i. e., characteristic and 

 entirely different from all other lepra lesions. 



3. The clinical symptoms of lepra begin in the nose. 



4. The relapses in the disease always begin with nasal 

 symptoms, such as epistaxis, congestion of the nasal mucous 

 membrane, a sensation of heat, etc. 



5. In incipient cases the lepra bacilli are first found in 

 the nose. 



Lesions. The lepra nodes in general resemble tubercu- 

 lous lesions, but are superficial, affecting the skin and sub- 

 cutaneous tissues. Rarely they may also occur in the 

 organs. Virchowf has seen a case in which lepra bacilli 

 could be found only in the spleen. 



Once established in the body, the bacillus may grow in 

 the connective tissues and produce chronic inflammatory 

 nodes the analogues of tubercles ; or in the nerves, causing 

 anesthesia and trophic disturbances. On this account two 

 forms of the disease lepra nodosa (elephantiasis graecorum) 

 and lepra an&sthetica are described. These forms may 

 occur independently of one another, or may be associated 

 in the same case. 



The nodes consist of lymphoid and epithelioid cells and 

 fibers, and are vascular, so that much of the embryonal 

 tissue completes its transformation to fibers without necrotic 

 changes. This makes the disease productive rather than 

 destructive, the lesions resembling new-growths. The 

 bacilli, which occur in enormous numbers, are often found 

 in groups inclosed within the protoplasm of certain large 

 vacuolated cells, the "lepra cells," which seem to be 



* " Mittheiluns^en und Verhandlungen der internationalen wissen- 

 schaftlichen Lepra-Konferenz zu Berlin," Oct., 1897, 2. Theil. 

 t Ibid. 



