the disease is prevalent.

Neisser states this: "The number of lepers in any country bears an inverse
ratio to the laws executed for the care and isolation of infected persons.
The disease appears to spread more rapidly in damp and cold, or warm and
moist, climates than in temperate countries. It is not now regarded as
contagious. The leprosy of the book of Leviticus not only includes lepra,
as that term is understood today, but also psoriasis, scabies and other
skin affections," The leper, in the eye of the Mosaic law, was
ceremoniously unclean, and capable of communicating a ceremonial
uncleanness. Several of the narratives contained in the Bible bear witness
to the fact that the Oriental leper was seen occasionally doing service in
the courts of kings, and even in personal communication and contact with
officers of high rank.

Symptoms.--Previous symptoms: Want of appetite, headache, chills,
alternating with mild or severe feverish attacks, depression, nosebleed,
stomach and bowel disturbances, sleeplessness. The durations of these
symptoms is variable. Some patients will remember that these symptoms
preceded for years the earliest outbreak of lepra (leprosy). In other
cases only a few weeks elapsed. These earlier skin lesions are tubercular,
macular (patches), or bullous elevations of the horny layer of the skin.
It may then be divided into three varieties tuberculous, macular and
anaesthetic.

LEPRA TUBEROSA. (Tuberculated, Nodulated or Tegumentary (skin) Leprosy).--
This nodular type comprises from ten to fifty per cent of cases. After the
occurring of the symptoms just mentioned spotted lesions appear, which are
bean to tomato in size, reddish brown or bronze-hued patches, roundish,
oval or irregular in contour, well defined, and they occur upon the face,
trunk and extremities. The skin covering them is either smooth and
shining, as if oiled, or is infiltrated, nodulated and elevated. The
surface of the reddened spots is often oversensitive.

[INFECTIOUS DISEASES 239]

After a period ranging from weeks to years, tubercles rise from the spots
described, varying in size from a pea to that of a nut, and they may be as
large as a tomato. They are in color, yellowish, reddish-brown, or
bronzed, often shining as if varnished or oiled, are covered with a soft,
natural, or slightly scaling outer skin, roundish or irregular in shape
and are isolated or grouped numbers of very small and ill-determined
nodules may