LEPROSY 6f 



count or by cyto-diagnosis (see pp. 227 and 237). Calmette'; 

 ophthalmo -reaction may also be used, but is by no means devoid o: 

 danger. 



LEPROSY 



The leprosy bacillus resembles that of tubercle, but it is 

 somewhat straighter and more uniform. It occurs in leprous 

 lesions in great profusion, and its discovery does not present any 

 difficulty. It has never been cultivated. 



In a suspected case of leprosy films should be made from the 

 nasal discharge, for the nasal cavities are very frequently affected 

 Indeed, it seems highly probable that the primary lesion through 

 which the bacilli gain access to the body is in the nose in most 

 cases. A small portion of one of the leprous nodules may also be 

 removed, and films made by rubbing the cut surface against s 

 clean slide. If there is an ulcer, films may be made from the 

 secretion from it. 



Films should be stained by the method which we have recom 

 mended for the tubercle bacillus. If bacilli are present in large 

 quantities, the case is almost certainly one of leprosy, for tubercle 

 bacilli are never found in similar situations except in scantj 

 numbers. If a doubt should arise as to the identity of the 

 bacilli, advantage should be taken of the fact that the leprosj 

 bacillus retains the fuchsin even more firmly than the tubercle 

 bacillus when exposed to the action of an acid. A film from the 

 suspected material should be spread at one end of the slide, and 

 some sputum known to be rich in tubercle bacilli at the other : 

 the whole should be stained by hot carbol fuchsin, and decolorized 

 by being immersed bodily in 25 per cent, sulphuric acid for hali 

 an hour. If the tubercle bacilli are decolorized, any bacilli which 

 have retained the red colour are almost certainly those of leprosy, 

 If the tubercle bacilli are not decolorized, a fresh specimen should 

 be prepared and immersed in the acid for a longer period. 



ACTINOMYCOSIS, OR STREPTOTHRICOSIS 



Actinomycosis is very closely allied to tuberculosis ; the lesions 

 appropriate to the two diseases are almost identical in histological 

 appearance, and the granuloma which occurs in actinomycosis 

 goes on to fibrosis or to the formation of " cold abscesses " just as 

 a tubercle may do. The formation of fibrous tissue is most 



