The statement of Sticker, who had found the bacillus in the nasal secretion in 83 per cent. of the patients examined, confirmed. Personally examined 142 cases with this object: 50 with nodular leprosy, and 92 with maculo-anmstbetie symptoms. The bacillus was discovered in 50 cases, 46 of which belonged to the nodular type and 4 to the anresthetic. Nearly all nodular lepers throw out large quantities of bacilli by the mouth in the act of sneezing or talking loudly, but this occurs more rarely during ordi nary conversation. Bacilli were not found as a result of forced expiration. Lie (Brit. Med. Jour., Jan. 26, 1901, from Lepra, vol. i, Fasc. 1 and 2).
Abrasions and solutions of continuity of the skin or mucous membrane, etc., may thus also afford an entrance to the specific germ.
Twenty-six cases observed in which in oculation occurred through accidental abrasions and other injuries. Chew (Med. Age, Dec. 27, '98).
Morrow advanced the theory that, like syphilis, leprosy was usually commu nicated by sexual intercourse. In Chew's statistics but 7 cases out of 1034 can be traced to coitus; but, as already stated, the period of incubation of the leprosy is long and the disease may thus fre quently be communicated and show signs of its existence long after intercouse. IIansen's bacillus has been found in semen.
In the hospitals in Rio Janiero some of the attendants have been attacked in spite of thorough precautionary meas ures. Period of inoculation appears to be, in some eases at least, as much as two years, and may possibly be longer. The disease is frequently associated with tuberculosis. Havelburg (Berliner klin. Woch., Nov. 16, '96).
Women in China are active dissemina tors of infection, "selling the disease," as they called it, in tbe belief that they can free themselves by coitus with a healthy man. James Cantlie (Lancet, Jan. 1, '98).
Of the 1034 cases studied 624 were mar ried, and in 4 cases only did the husband infect his wife, while on 3 occasions the wife infected her husband. While 44 of the married lepers had had no children, there were no fewer than 1566 concep tions. R. S. Chew (Med. Age, Dec. 27, '98).
[Dr. Chew's statistics seem to invali date the view that impotence accounts for limited birth-rate among lepers. As in the case of syphilis, it is more prob able that the influence borne exerts itself upon fcetal development. C. E. DE M. Smous.]
Sex does not seem to have much in fluence upon the development of the dis ease, though male lepers are by far the more numerous. It may attack children as well as adults, but it is most frequently met with in persons between twenty and forty-five years of age: the period of life attended by the greatest exposure.
From an investigation of 1034 lepers in every stage of the disease tbe annexed table gives the conclusions reached as to etiology. Roger S. Chew (Medical Age, Dec. 27, '98).
Distribution.—Leprosy is most prev alent in India, where, according to Zam baco, there are 130,000 cases; but the disease is thought to be increasing. It is also met with extensively in China; but less so in Persia, Japan, Tonquin, Siam, Anam, the Antilles, and South America.
it is estimated that there are 30,000 lepers in the departments ot Boyaca and Santandeo, in the United States of Colombia. E. II. Plumacher (Abstract of Sanitary Reports, Nov. 13, '91).
Leprosy also exists in Norway, Sweden, Russia, Spain, Italy, Roumania, Greece, Turkey (at least 4000), and in a modified and light form in France.
In the English-speaking sections of North America the cases are compara tively few., An inquiry by Dr. Osler has elicited. the fact that there were five foci, two in Canada, aggregating about 40 cases, and three in the United States, aggregating about 300 cases. Dr. I. Dyer, at the Berlin Leprosy Conference, reported that there were 126 cases in Louisiana. Wisconsin and Minnesota are computed to contain about 150, all Swedes and Norwegians. The cases are gradually decreasing in number. In the Hawaiian Islands, according to Morrow, there are about 1200 cases at Molokai. Sporadic cases are occasionally met with in our cities.
Since 1866 five deaths from leprosy have been reported in New York. Edi torial (Brit. Med. Jour., Dec. 19, '91).
Pathogenesis.—A specific bacillus closely allied to the bacillus of tubercu losis has been shown by IIansen in 1871 to be the exciting cause of leprosy. The labors of Neisser have confirmed Han sen's discovery. The bacillus leprffl is a long and slender, motionless rod, with slightly-tapering ends. It reacts in the same way that the tubercle bacillus does to coloring reagents, but much more readily—a distinctive feature—and takes aniline dyes, which tubercle bacilli do not. Again, the bacilli of leprosy are usually much more numerous.