LEPROSY 97 



| 



to the Gabbett method, where decolorizer and counterstain are com- 

 bined: i. We cannot judge of the degree of decolorization we are 

 working in the dark; and 2. the matter of elimination of smegma bacilli 

 is impossible. 



Pappenheim's method, in which corallin and methylene blue are dissolved in 

 alcohol, does not appear to have an advantage over acid alcohol. As a practical 

 point when the question of tuberculosis of the genito-urinary tract is involved, 

 inoculate a guinea-pig with urinary sediment. 



It must be remembered that in young cultures of tubercle bacilli many of the 

 rods are nonacid-fast, taking the blue of the counter stain, while older rods are 

 acid-fast. This frequently causes suspicion of a contaminated culture. 



Discussion has arisen as to the granules of Much. These are considered by Much 

 as resistant forms while others consider them degeneration forms of tubercle bacilli. 

 At any rate material containing only these Gram-positive granules and no acid-fast 

 rods may when injected into animals give rise to tuberculosis and acid-fast bacilli. 



The combination of the acid-fast and Gram-staining methods as recommended 

 by Fontes is very satisfactory. 



Bacillus Leprae (Hansen, 1874). This is the cause of leprosy. In 

 nodular leprosy the organism is readily and in the greatest abundance 

 found in the juice of the tubercles of the skin, and secretions of ulcera- 

 tions of nasal and pharyngeal mucosa. 



The earliest lesion is probably a nasal ulcer at the junction of the bony and 

 cartilaginous septum. Scrapings from this ulcer may give an early diagnosis. 



In the skin they are chiefly found in the derma packed in the so-called lepra 

 cells. The process is granulomatous but does not show the caseation of tubercu- 

 losis or the predominant plasma cells of syphilis. The bacilli are also found engulfed 

 in the endothelial cells lining the lymphatics. 



They are also found in the glands in relation to the superficial lesions. The 

 bacilli are found in smaller numbers in the liver and spleen. In anaesthetic or nerve 

 leprosy they are found in small numbers in the granuloma tissue which affects the 

 interstitial connective tissue of the peripheral nerves. Also, rarely, in the anaesthetic 

 spots of nerve leprosy. 



The leprosy bacilli are found in profusion in the granulomatous tissue of the 

 corium and subcutaneous structures of the leprous nodules, chiefly within cells 

 called "lepra cells" and also within endothelial and connective-tissue cells as well 

 as lying free, packed in lymphatic channels, the so-called "globi." 



The leprosy bacillus may be distinguished from the tubercle bacillus 

 by the following points: 



i. The presence ordinarily of huge numbers of bacilli often grouped 

 in packets like a bundle of cigars tied together. It will be remembered 

 that it is very difficult to find even a single tubercle bacillus in a skin 

 lesion. Leprosy bacilli form palisade groups but not chains. 



