LEPROSY. 247

son,1 the bacteriological diagnosis of nodular leprosy can
be made by spreading the 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 present in enormous numbers, thus forming a marked
contrast to the tubercular skin diseases, in which very few
can be found.

In that form known as anesthetic leprosy, nodules form
upon the peripheral nerves, and by connective-tissue
formation, as well as the entrance of the bacilli into the
nerve-sheaths, cause irritation, then degeneration, of the
nerves. The anesthesia which follows these peripheral
nervous lesions is one of the conditions predisposing to
the formation of ulcers, etc. by allowing injuries to occur
without detection and to progress without observation.
The ulcerations and occasional loss of phalanges that
follow these lesions occur, probably, in the same manner
as in syringomyelia.

The disease advances, having first manifested itself
upon the face, extensor surfaces, elbows, and knees, to the
lymphatics and the internal viscera. Death ultimately
occurs from exhaustion, if not from the frequent inter-
current affections to which the conditions predispose.

1 Montreal Med. Journal, Jan., 1897.