“ As the disease progresses the nodules tend to break down and ulcerate, leaving open sores. The patient, whose condition is extremely wretched, gradually becomes weaker, and eventually succumbs to exhaustion or is carried off by some intercurrent disease, usually inflammation of the kidneys or tuberculosis. A severe case may end fatally in two years, but, as a rule, when patients are well cared for the illness lasts several years. There is often temporary improvement, but complete recovery from this form of leprosy rarely or never occurs. ”

“ Vaccination is a new thing, leprosy a very old one; where there is most vaccination there is no leprosy, and where there is most leprosy there is little or no vaccination. In India 78% of the lepers are unvaccinated, and in Canton since vaccination was introduced leprosy has declined (Cantlie) . On the whole we must conclude that there is still much to be learnt about the conditions which govern the prevalence of leprosy. ”

“ Except in Spain, where some increase has taken place, the disease is dying out. The number of lepers in Norway was 3000 in 1856, but has now dwindled to a few hundreds. They are no longer numerous in any part of Europe. On the other hand, leprosy prevails extensively throughout Asia, from the Mediterranean to Japan, and from Arabia to Siberia. It is also found in nearly all parts of Africa, particularly on the east and west coasts near the equator. In South Africa it has greatly increased, and attacks the Dutch as well as natives. ”

“ The disease runs a very chronic course, and may last twenty or thirty years. Recovery occasionally occurs. In the mixed form, which is probably the most common, the symptoms described are combined in varying degrees. Leprosy may be mistaken for syphilis, tuberculosis, ainhum (an obscure disease affecting negroes, in which the little toe drops off) , and several affections of the skin. Diagnosis is established by the presence of the bacillus leprae in the nodules or bullae, and by the signs of nerve degeneration exhibited in the anaesthetic patches of skin and the thickened nerve trunks. ”

“ But we see the disease persisting among the Eastern races, who have been continuously exposed to its selective influence from the earliest times, while it has disappeared among the Europeans, who were affected very much later. ”

“ These patches are the result of morbid changes affecting the cutaneous nerves, and are accompanied by diminished sensibility over the areas of skin affected. At the same time certain nerve trunks in the arm and leg, and particularly the ulnar nerve, are found to be thickened. In the further stages the symptoms are those of increasing degeneration of the nerves. Bullae form on the skin, and the discoloured patches become enlarged; sensation is lost, muscular power diminished, with wasting, contraction of tendons, and all the signs of impaired nutrition. The nails become hard and clawed ”

“ Scrupulous cleanliness should be exercised by persons attending on lepers or brought into close contact with them. In treatment the most essential thing is general care of the health, with good food and clothing. The tendency of modern therapeutics to attach increasing importance to nutrition in various morbid states, and notably in diseases of degeneration, such as tuberculosis and affections of the nervous system, is borne out by experience in leprosy, which has affinities to both ”

“ The tissues of the eye undergo degenerative changes; the mucous membrane of the nose and throat is thickened, impairing the breathing and the voice; the eyebrows fall off; the ears and nose become thickened and enlarged. ”