BLASTOMYCOSIS AND LEPROSY 329 
In a later publication, he ! notes the occurrence in a number of patients of a 
condition peculiarly akin to maculo-anaesthetic leprosy. He points out that the 
resemblance is not a slight one, as is borne out by the fact that the natives 
affected with this condition are reported as lepers by their associates. Many of 
them, too, seen for the first time in the out-patient department, he says, are re- 
garded with suspicion and labelled ‘‘ query leprosy.” Those affected are in the 
main young male adults, enjoying apparently perfect health. Areas of the skin 
involved may be single or multiple, usually asymmetrical and situated on the 
face, back, abdomen, or upper limbs. <A typical patch is seen to be distinctly 
lighter than the surrounding normal skin, being of a characteristic brownish- 
yellow tint. The outline is commonly serpiginous or gyrate in character, but 
ringed or plaque-like areas also occur. In these latter, the central parts are 
smooth and are evincing a tendency to return to the normal pigmented con- 
dition, whereas the periphery is raised and presents features in common with the 
gyrate or serpiginous forms. The skin in such an area is definitely raised and 
infiltrated, the infiltration being papular in nature. These papules are flattened 
and present a smooth, almost shining or polished surface. Scaliness may be 
present to a very slight degree. The condition is very chronic and never tends 
to ulceration unless superadded infection with pathogenic organisms intervenes. 
For the differentiation from leprosy, Smith used the examination of a piece 
of the involved area and the test for anidrosis. For the latter he injected intra- 
cutaneously or subcutaneously a few drops of a solution of pilocarpine nitrate. 
He says that the appearance of sweat, in the form of minute drops, to approxi- 
mately the same extent in a diseased area and a normal area of the skin, is strong 
evidence that the condition is of a non-leprotic character. He admits, however, 
that anidrosis of itself must not be regarded as certain evidence of leprosy. 
In the study of the histological preparations, including stains for acid-fast 
bacilli and Levaditi’s method, he found that the superficial epithelium showed 
but little change except in the region of the hair follicles. Many of these appeared 
to be markedly distended with degenerate masses of hyalinised material, pre- 
sumably derived from the horny epithelium. The sebaceous ducts, as they enter 
the hair follicles were also involved. In many of the follicles so affected, the hair 
was present in the center of the distended follicle and was surrounded by a dense 
layer of ‘“‘bottle bacilli.””,. He remarks that they might be confused with Monilia, 
but their variation in size, the typically ovoid or flattened shape, the absence of 
any mycelial elements, and the fruitless attempts at cultivation on the ordinary 
media, all helped to apprise him of their true nature. Scanty “bottle bacilli’ 
occurred scattered throughout the hyalinised material and also in a few of the 
sebaceous gland ducts as they open into their respective follicles. He found that 
it was in the earlier lesions that the histological changes could be best studied. 
Where some of the affected hair follicles were cut through in their deeper portions, 
the hair was seen to be lying eccentrically, the hyaline material occupying the 
follicle as a plug. Many of these plugs showed a faintly-staining amorphous or 
granular central area and contained numerous slender gram-positive bacilli 
1 Smith: West Africa Med. Jour. (1928), XI, 91. 
