PART II.] Classification of Cases Based on Predominance of Symptoms. 457 



resident native doctor attached permanently to it. Of the 36 lepers admitted into 

 the Asylum previous to 1866, 14, or 38-8 per cent., are dead ; the rest, with the exception 

 of 5, are now in the Asylum. Of the 175 cases admitted since 1866, 62, or 35-4 per cent., 

 have died, 38 have left the Asylum, and 75 remain. That the percentage of deaths should 

 be so nearly equal in the two cases is no doubt owing to the fact that the majority 

 of deaths occur among recent admissions, and are probably due to the tubercuiated 

 form of leprosy, which is known to run a more rapid course than the anaesthetic form. 

 The number of inmates of the Asylum during our visit was 80, excluding a few spurious 

 or doubtful cases. 



All the recognised forms of true leprosy are represented among the inmates, although 

 in very unequal proportion, there being 49 cases in which anaesthetic phenomena form 

 the prominent symptoms, 12 in which the tubercular element prevails, 4 in which 

 eruption is very conspicuous, and 15 in which tubercuiated and anaesthetic phenomena 

 are so closely and equally associated that they may with propriety be regarded as cases 

 of the " mixed " variety of leprosy.* This division of the cases is, however, to be regarded 

 as a relative one only, founded on predominance of symptoms. The cases classed as 

 " anaesthetic " were invariably, or almost invariably, comparatively pure cases of this 

 form ; but in advanced cases of tubercuiated leprosy, the phenomena are very rarely, 

 if ever, dissociated from more or less pronounced symptoms of anaesthesia, so that they 

 might generally be included under the heading of mixed cases. Still the one condition 

 was so much more strongly marked than the other, that it appeared warrantable and 

 conducive to clearness to retain them under a distinct heading. The same holds 

 in regard to those classed as " eruptive," the very small proportion of which cases 

 is noteworthy, and is probably, in part at all events, to be ascribed to the fact that 

 patients do not generally present themselves for admission until the disease has lasted 

 for some time, and until, in consequence, eruptive symptoms have disappeared, or 

 have been obscured by the development of anaesthetic or tubercuiated phenomena. This 

 is the more probable as, in the vast majority of cases, the patients suffering from advanced 

 tubercular or anaesthetic symptoms described their disease as having commenced with 

 the occurrence of an eruption. 



Whilst at Almora we endeavoured to select typical examples of the two leading 

 forms of leprosy for the purpose of illustrating their more prominent features. Several 

 such cases were photographed, but we have thought that three would be sufl&cient for 

 our present purpose. Eeproductions of these accompany the present report. 



Speaking generally, the plates may serve as illustrations both of the anaesthetic 

 and tubercuiated forms of the disease. The eruption presents a prominent feature in the 

 case which we selected of the former (Plate XXIX), especially on the dorsal surface of 

 the trunk; but numerous little nodular elevations may also be observed when the 

 photograph of the chest of the same individual is closely examined (Plate XXX). It 



* These figures do not give a total corresi)onding with that derived from the tables of admissions, due to the 

 fact that a few doubtful cases are inmates of the Asylum. 



