354 THE LEPROSY BACILLUS 



agglutinating and haemolytic properties for human blood : a given volume of the 

 serum agglutinated at once and dissolved in 7 minutes all the red cells in an equal 

 volume of human blood. 



When injected into lepers in doses of 1, 3, and 7 c.c. this serum to some extent 

 relieved pain, and caused congestion and suppuration of some of the lepromata 

 with the result that sloughs formed which afterwards became detached : in a few 

 cases an insignificant febrile attack was noticed. In short, the results of using 

 Metchnikoff's serum, although not so good, were very similar to those obtained 

 with the serum prepared by Carasquilla, Laverde, and others. 



In Metchnikoff's opinion the favourable results following the use of such serums 

 should be attributed to the leucotoxin developed in response to the inoculation into 

 the tissues of an animal of human leucocytic products ; this leucotoxin should in 

 suitable doses lead to stimulation of the leucocytic system : the haemotoxin is of 

 no therapeutic value, and indeed prevents the employment of sufficiently large 

 doses of serum. The obvious conclusion from this argument is that in the treat- 

 ment of leprosy an attempt should be made to prepare an antiserum by inoculating 

 an animal with blood serum alone or better still with human lymphatic glands. 



SECTION IV. DETECTION AND IDENTIFICATION OF THE 

 LEPROSY BACILLUS. 



Microscopical examination is at present the only means of detecting the 

 leprosy bacillus. Sections should be cut and films made of the suspected 

 tissues and fluids. [Cultures should however be attempted.] 



The bacillus of leprosy is found in the leprous nodules, bone marrow, 

 and spleen. The bacillus can also be found in the glands, in the swellings 

 along the nerves, in the discharge from ulcerating lesions, in the saliva when 

 the buccal mucous membrane is affected, in the stools when the disease infects 

 the large intestine, in the secretion of the testicle when that organ is involved, 

 in the milk (Babes), etc. Sticker has drawn attention to the presence of the 

 bacillus in the nasal mucus. Nasal lesions are commonly present from the 

 early stages of the disease and were found in 128 out of 153 lepers examined 

 by Sticker ; examination of films of the nasal mucus will therefore often 

 afford confirmation of the diagnosis. 1 



Leprous nodules consist of large cells, similar to epithelioid cells, having 

 as a rule a single nucleus and crammed full of bacilli : these constitute the 

 lepra cells. The leprosy bacillus is therefore intra-cellular. 



During life portions of a leproma can be easily excised, since it is known that 

 in the majority of these lesions there is an absence of all sensation. Manson recom- 

 mends isolating a succulent leproma in a pile clamp, slowly screwing up the jaws 

 of the instrument so as to drive out the blood, pricking the now pallid leproma and 

 then collecting on a cover-glass the droplet of " leper juice " which exudes from 

 the puncture. 



Arning has never found the bacillus in the blood. According to Cornil, 

 Babes and Goujerot the bacillus enters the blood stream a few days before 

 death and especially during the febrile attacks. 



The following technique is recommended for the detection of the bacillus : 

 (a) Stain films by Ziehl-Neelsen's method. The leprosy bacillus is dif- 

 ferentiated from the tubercle bacillus by three tests 



1. Simple staining with a watery alcoholic solution of fuchsin ; 



2. Gram's stain ; 



3. Baumgarten's method of staining. 



1 In examining films of the nasal mucus care must be taken to distinguish the leprosy 

 bacillus from the bacillus of Karlinski. The latter bacillus is found in the nasal mucus of 

 man quite apart from leprosy or tuberculosis : it gives rise to no symptoms, morphologi- 

 cally resembles the bacillus of leprosy, and is acid-fast. In cultures, it grows easily 

 on ordinary media, and is pathogenic to guinea-pigs when inoculated intra-peritoneally. 



