CHAPTER XXI 



THE BACILLUS OF LEPROSY, THE SMEGMA AND OTHER ACID-FAST 



BACTERIA 



The bacillus of leprosy, so far as known, infects man only. This is purely a 

 parasitic organism that has not been successfully cultivated outside the human 

 body. It is probable that the leprosy bacillus, deposited in the sputum, nasal 

 secretions, feces and discharges from lesions of the disease, on clothing, utensils, 

 etc., may survive and retain its infectiousness for some time. 



The leprosy bacillus is usually present upon the mucosa of the nares from 

 the early stages and throughout the disease. It is present in the enlarged glands, 

 some of the nodules and in the ulcerative lesions of the disease. 



When the lungs are involved, sputum may contain them, and when the 

 intestines are affected leprosy bacilli may be found in the feces. 



Diagnosis. Bacteriological diagnosis is based upon microscopic examina- 

 tions. In every case a sterile cotton swab should be rubbed over the nasal 

 mucous membrane and then rubbed on a clean slide. If ulcers exist smears are 

 made from the necrotic surface and small pieces of the base of the ulcer removed 

 for microscopic examination. If ulceration has not occurred, nodules and en- 

 larged glands are sought for, massaged, and fluid extracted from them and spread 

 on slides. 



After drying, the slides are stained exactly as for tubercle bacilli, the leprosy 

 bacillus having the same morphology and staining characteristics as the tubercle 

 bacillus. The lesions of leprosy contain very many leprosy bacilli, some of the 

 tissue cells containing large numbers of them; this is a differential point between 

 leprosy and tuberculosis. 



When clinical signs and bacteriological findings furnish inadequate evidence, 

 X-ray examinations of the bones of the feet and hands frequently show char- 

 acteristic changes. 



THE SMEGMA BACILLUS 



The smegma bacillus is frequently present upon the external genitalia of both 

 men and women, occasionally on the adjacent cutaneous surfaces and rarely in 

 the mouth or on the tonsils. It is a non-pathogenic saprophyte similar to the 

 tubercle bacillus in many respects and differentiated from it by the following: 

 (i) The smegma bacillus is acid-fast, but not alcohol-fast; Pappenheim's solu- 

 tion, after carbol f uchsin, decolorizes it in less than 20 minutes. (2) The smegma 

 bacillus does not produce tuberculosis when inoculated into guinea-pigs. (3) The 

 smegma bacillus does not produce tuberculin. 



There are numerous acid-fast bacteria, including Rabinowitsch's butter 

 bacillus and Moeller's grass bacilli, morphologically indistinguishable from the 

 tubercle bacillus, which occur in air, soil, water, milk, butter and cheese. None 



