1652 



LEPROSY 



bacilli surrounded by mucus, forming the ' globi.' Beneath the lesion the 

 connective tissue may be more or less normal. 



The attacks of fever and the erysipelatous eruptions, which will be described 

 under the Symptomatology, are explicable by the dissemination of the bacilli 

 throughout the body by the blood stream, the bacilli being contained in the 

 large mononuclear leucocytes, according to Marchoux and Bourret, and by the 

 embolism of the capillaries of the skin by bacilli and white cells, which, how- 

 ever, are soon recovered from. 



Lesions may remain stationary for years, and retrogression may take place 

 as the result of treatment, or spontaneously, in which case the dead bacilli 

 are absorbed, and sac-like spaces left, which rarely become sclerosed by 

 connective tissue. If on a surface, the leproma may soften, break down, and 

 ulcerate, thus disseminating the bacilli in the discharge. 



The bacilli may also enter into the nerves and cause a hyperplasia of the 

 connective-tissue cells of the coats and the formation of typical leproma 

 cells at first around the vasa nervorum, and later in the perineurium and 

 endoneurium. 



These cells press on the nerve fibres, causing a degeneration of the neuri- 

 lemma, and later a disintegration of the arteries and a destruction of the 

 nerve fibres, which finally results in the nerve being largely converted into 

 connective tissue. In places where the nerve is apt to suffer from compres- 

 sion or other slight injuries, it becomes so thickened as to be easily palpable — 

 a fact which Lie explains by saying that the bacilli which he found in the 

 cutaneous nerves pass up the nerves and become located at spots liable to 

 injury. 



It is usually believed that the nerves only are affected, and that the paralyses, 

 etc., are the results of disease of the peripheral nerves, but it has been shown 

 that the bacilli attack the anterior cornua of the spinal cord, and therefore 

 this may play a part in the production of the symptoms. 



The bacilli may be carried by the blood stream all over the body, but show 

 a selective affinity for certain organs, in which they develop the typical 

 leprotic lesions. A certain number of leprotic subjects react to tuberculin 

 injections, and give a positive Wassermann reaction. 



Morbid Anatomy.— The skin lesions which may be found are the 

 tubercles, which may or may not be ulcerated, and the pigmented 

 and apigmented areas. On cutting into the leproma, it is seen to be 

 situated usually in the cutis, and covered by the epidermis; but it 

 may lie in the subcutaneous tissue, in which case it does not form 

 a tubercle. It is yellowish-white in colour, firm in consistency, 

 and if squeezed, usually a little clear fluid can be obtained. It 

 will be noted that the sweat and sebaceous glands and the hair 

 follicles are compressed and as a rule atrophied, while vesicles 

 and pustules may occur on the surface, which may be ulcerated 

 and covered with crusts. The macules consist of round-celled 

 infiltration, with but few large cells, which are generally free from 

 bacilli. In the spots which during life were anaesthetic, which are 

 derived from the macules, the corium is largely converted into 

 fibrous connective tissue, which has caused glands and hairs to 

 atrophy and disappear. 



The typical lepromatous infiltration may occur, not merely in 

 the skin, but in the mucosae of the tongue, pharynx, larynx, epi- 

 glottis, and in the submucosae of the intestine. 



The liver, which is usually enlarged, shows a leprous infiltration 

 of the portal systems, while the spleen, which also may be enlarged, 

 shows the same along the course of its vessels, particularly while 



