746. Leprosy 



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 tuberculous 



lesions, but are superficial, affecting the skin and subcutaneous 

 tissues. Rarely they may also occur in the organs. Virchow* 

 has seen a case in which lepra bacilli could be found only in the spleen. 



Once estabUshed in the body, the bacillus may grow in the con- 

 nective 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 ancestketica, 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 re- 

 sembling 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 partly degenerated endothelial cells. Sometimes they are 

 anuclear; rarely they contain several nuclei (giant ceUs). Bacilli 

 also occur in the lymph-spaces and in the nerve-sheaths. 



Lepra nodules do not degenerate so readily as tubercles, and the 

 ulceration, which constitutes a large part of the pathology of the 

 disease, seems to be largely due to the injurious action of external 

 agencies upon the feebly vital pathologic tissue. 



According to the studies of Johnston and Jamieson,t the bacterio- 

 logic diagnosis of nodular leprosy can be made by spreading serum, 

 obtained by scraping a leprous nodule, upon a cover-glass, drying, 

 fixing, and staining with carbol-fuchsin and Gabbet's solution as 

 for the tubercle bacillus. In such preparations the bacilli are pres- 

 ent in enormous numbers, forming a marked contrast to tuber- 

 culous skin diseases, in which they are very few. 



In anesthetic leprosy nodules form upon the peripheral nerves, 

 and by connective-tissue formation, as weU as by the entrance of 

 the bacilli into the nerve-sheaths, cause irritation, followed by 

 degeneration of the nerves. The anesthesia following the peripheral 

 nervous lesions predisposes to the formation of ulcers, etc., by allow- 



* "Mittheilungen und Verhandlungen der internationalen wissenschaftlichen 

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

 T "Montreal Med. Journal," Jan., 1897. 



