XXII 
LEPROSY AND COMPLICATING INFECTIONS 
Leprosy is common in Liberia, both in the interior and on the coast, as well as 
in the Central Congo. Cases could be found in most of the villages of Liberia. 
No attempt, of course, is made to isolate the patients throughout Liberia or in 
parts of the Congo where individuals with leprosy mingle freely with the other 
inhabitants of the villages. 
The trophoneurotic form was more common in Liberia than the nodular or 
tubercular. While usually the disease in Africa offered no difficulty in diagnosis, 
in some cases the diagnosis was made with very great difficulty. In a number of 
instances we observed the loss of one or more toes in individuals in whom the 
condition could not always be explained satisfactorily as the result of ainhum 
or of some injury. Such lesions sometimes suggested that they were the result 
of leprosy. However, in some instances, even where the ends of the toes were 
granulomatous, no acid-fast bacilli were found in film microscopical preparations, 
while in other similar cases leprosy bacilli were discovered. The absence of 
leprosy bacilli in such eases, if the lesions are purely trophoneurotic, does not 
exclude leprosy. 
It may be recalled that Zambaco believes that all uncommon mutilations, 
such as ainhum for instance, are forms of leprosy, though he has given no proof 
of this hypothesis. 
In a number of instances, particularly in Liberia, the disease seemed to have 
reached a quiescent or arrested stage. One might have expected to see among a 
number of Liberian tribes a greater number of cases of more advanced leprosy 
than we did, and not so many with arrested forms of the disease. Such a con- 
dition can, perhaps, sometimes be explained on the ground that leprosy is a very 
chronic disease and that numbers of these people have gradually developed or 
acquired a tolerance or immunity against the infection. Obviously their im- 
provement or recovery has not depended on any treatment or upon favorable 
hygienic conditions. 
Among the readily recognized cases of leprosy, the nodular type predomi- 
nated, and in them there was no difficulty in demonstrating the Bacillus leprae 
(No. 246). Many of these patients also showed ulcers with spontaneous am- 
putation of toes or fingers and areas of anaesthesia. Still others had naso- 
pharyngeal lesions indistinguishable from gangosa or extensive scarring like that 
seen in tertiary yaws or n’gonde. In such cases, it seemed not unlikely that the 
entire picture was produced by a combination of leprosy and treponemiasis. 
In some instances the evidences of treponemiasis were most striking, but the 
patients also showed features suggesting leprosy. Cases 531 and 385 are in- 
318 
