CURRENT LITERATURE

CURRENT LITERATURE It is intended that the current lit eratur e shall be dea lt with in this departm,ent. It is a fun ction of th e Contributing Editors to provide abstra cts of all articles published in th eir t erritories, but when necessary such '/1w lerial ft'om oth er sources is used wh en pro cura ble. ~

KRAMCHANINOV, N. Ji'. [O n the history of the stud y on leprosy in Russ ia. The work of P. Simontovskii. ] Vestnik Dermatol. i Venerol. 33 (1959) 61 -62. P. Simontovski i, in 1796, studied the lep rosy situati on in th e town of Uralsk, whet'e he found about 70 cases. Hi s descriptions of these cases give us a rathcr detail ed clini c pi cture of lepromatous leprosy, anesthesia, plantar ul cers, stcnosis of the larynx, deformity of the nose, etc. H e stressed the fnct that leprosy is a contagious disease, a nd recommended the establi shment of special houses in which to pln ce the patients. His work " The Description of the Disease Elephantia sis" was received by th e Medical Colleg ium , but was not published . The author of this article discovered this work in the nrchives of the Medical Coll cgium.- N. TOR-SUEV I NNES, J . R.

Ru ssi ~1Il

papers on leprosy. Leprosy Rev. 31 (1960) 278-282.

The author considers materilll sup pli ed by Prof. N. A. Torsuev, of Ro. tov-on-Don. This consists, first, of Torsuev's own llssesslli ent of Russilln literature, whi ch contains infol'mlltion on the ba sis of lep rosy work (dispensa ries of the health servi ce ) , and notes on special studies-in cluding observation of the early reactions by Stein and Steperin in 1931 (antedating Fernandez by several years ), and a paper on acute fwd chronic vaginiti s of leprosy. The other is an amllysis by subj ects of a bibliog raphy, which lists 1,975 items in Russian and 664 item s in other languages.- H. W. W. [KgNYA] Medical Department, Colony and Protectorate of K enya, Annual r eport for 1958. Nairobi: Governm ent Printer, 1959. Surveys in thp NYll nza Provin ce made in 1957 showed an incidence of 10 p er mille, with approximately 10% lepromatous. This g ives a total of ahout 20,000 cases in the province (N yanza Province has the highest incidence of leprosy in K enYfI ). In 1957, 1,072 outplltients and 218 inpatients had started treatment; in 1958, the number were 813 outpatients and 349 inpatients. No figures ar e given for those under treatment nor for cured cases.- J OnN GARROD [KENYA] Ministry of Health, Colony and Protectorate of K enya, Annual r eport for 1959. Nairobi: Government Printer, 1960. Consideration was given to the establishment of treatment villages. The first village built wa s burned down. The policy of building up a treatment and preventive program based on the normal.health:,cwganization has been followed. There are 2 leprosaria, one at Alupe in Nyanza Province and one at Tumbe in the Coast Provin ce. Surveys indicate a total of 25,000 cases, with 20,000 in Nyanza Province and 2,000 in the Coa t Provin ce, giving p revalence rates of 8.4 and 3.6 per 1,000, respectively. The incidence of leproma.tous leprosy in Nyanza Province is .74 p er 1,000 of the population . There were 1,071 new outpatients and 246 new inpati ents.- JoHN GARROD [UGA NDA] Annual r eport of the Mediclll Department for the year ending December 31, 1957. Entebbe, Government Printer, 1958. The estimated total of leprosy cases is 70,000. The prevalence varies from 13 to 43 per 1,000, heing highpst in the Eastern Province and in the foothill s of the Ruwenzori

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Mountain s in Westel'll Province. Treatment is mainly by oral sulfones, di stributed through 5 leprosa l'in I'un by missions and 73 treatm ent vill ages run by com munal effort with ma tching assista nce f rom the territorial governm ent. A total of 30,000 cases were under treatm ent. Investigations into epid emiol ogy continued. District councils, missionary societies, the British Leprosy Relief Association, and the territorial government cooperated well. Assistan ce with drugs and equipment wa s received f rom U\fI CEF. Special g rants for leprosy work f rom the territorial govel'l1m ent fo r recurrent expendi ture were £7,775 and £1,000 for capital expenditure.- JOT-TN GARROD [UGANDA] Annua l report of the Medical Department fo r the yem' ('Ilding Decf'll lber 31, 1958. Entpbbe, Govel'llm ent Printer, 1959. ' Of th e estilll llted total of 70,000 cascs of lep rosy, 9% are considered lepromatous; 19% of nil cases were children; 32,217 were attending for treatment; 14,549 wcre f rom Northcl'l1 Province, 3,910 f r om Buganda, and 3,597 from Westel'll Provin ce. Acco lll modat ion wa s availabl e for over 4,000 in 73 treatment villages, and fo r over 3,000 in 5 settlements run by missions. Th er e were 9,959 new patients, and 1,764 had been diseluuged as cured. Special govel'llm ent grants for' capital a nd r eCUl'l'ent expenditure totalled £8,942, a slightly greater amount than in 1957. Two treatment vill ages were cl03ed because no longer needed, and 2 others were opened elsewhere. Mi ssions, territorial govel'll men t, local coun cils, UNI CEF and BELRA continued in close cooper ation. Investigations into epiilemiology were continued, using a especia ll y mod ified lepl'omin.- JoHN GARROD [EAST AFRICAN I NSTl'l'U'I.'E FOR MEDICAL RESEARCH.] Annual Report 1959-60. East Africa High Comm ission, 1960. On e th ousa nd two hundred cases of leprosy in two leprosaria were exam in ed especia Ily for eye lesions, which were fo und in 111 cases, some of which had multiple lesions. The commonest conditions were keratitis (48 cases), irititis (35 cases) and lagophth almos (21 cases ).- J oHN GARROD [ ZANZIBAR] Health Department, Zanzibar Protectorate, Annual Report fo r 1958. Zanzibar, Government Printer, 1959. - - - Idem. Annual r eport for 1959, Ibid. , 1960. There ar e two leprosaria, Walezo in Zanzibar, maintained by the Gove rn ment and staffed by the local Roman Catholic Mission, and Makondeni on Pemba I sland, which is a governm ent instituti on. Each ca n accommodate approximately one hundred patients. In ad diti on, outpatients are treated at rural health center s. The total und er treatment at the end of 1956 was 180, at th e end of 1957, 156; at the end of 1958, 83; and at the en d of 1959, 100. The hope is expressed that it will soon be possible to close one of the leprosa ria. In 1D58 ther e were 55 new cases; in 1959, 44.- J OHN GARROD [QUE~~KSLAND]

Annual report of the Health and Medical Servi ces of the State of Queensland for the Year 1959-60. Brisbane, GoveJ'l1lllent Printer, 1960.

On August 5, 1959, the patien ts were r emoved from P eel I sland , which had been in operation since 1907, and were housed in a specially converted building in th e Chronic Diseases Section of the Princess Alexandra Hospital in South Brisbane. An outp:-ltient clinic is also held there once a week. What with 5 patients di scharged to " home i ·olation," there were onl y 6 regulars left-of which 3 were elig ibl e for discharge but allowed to remain. At Fantome I sland, the · leprosarium for aboriginal s u nder the F r anciscan Missionaries of Mary, the nu mber is also reduced, fro1]1 23 to 17. Some of the patients have been temporarily transferred to Townsvill e Gener~L HospitaJ.- H.W.W.

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[ \" ESTER~

AUSTRALIA] R eport of the Commissioner of Publi c H ea lth fo r 1958. Perth : Go \'e rnm ent pJ·inter. - - - Idem, 1959. (1 ) The usufl l tllble sholl's that of th e total of 150 patients r em::unll1g in th e lepr osariu m at th e end of the yellr, 92 wer e mal es Ilnd 58 females. Of the 41 cases admitted (30 males and 11 fe males ) , 20 were rendmiss ions (said by Davidson , in the sp ecial article noted hel ow, to have been mostly f wn1 the ea rlier days of chelll otherapy wh en the effe cts of th e sul fo nes 11lld been over-estimat('d, Il nd when dischn rge' were mll2e earlier than now .) There had been no absconding, and no pati ents hnd been discharged " Il onin fect ious," onl y "cured," of whi ch th ere had been 59. (2 ) ,Yith no discussion onl y th e usual tllbl e is g iven, which shows the number r Cllln ining nt th e ('nd of the yellr to have been f urth er r educed to 126. Admissions had tota ll ed onl y 24 (14 ma les and 10 fe mnl es), of whi ch 13 w('I'e r ea dmi ssions. The number di scharged (a ll "cured" ) wa s 45.-H. "W. IV. ])AVID SO~}

IV. S. Leprosy report. I n Report of the Commissioner of Public Health [\Vestern Australia] for the yea r 1958. P erth , Government Printer, 1959, pp. 60-62. Chemoth erapy Iwing' a post-war introduction , whi ch has r evolutioni zed trea tment and [llso manag ement nnd pl'Pvention , the last 12 yeA rs of work are r eviewed. Introduced among the aborig in al. ' nhout the tum of the centu ry, leprosy is a compHrativel y new di . ease nmong a nonimillun e population and ther efore shows a probably truer pi cture than is seen el. ewhere a ll lOng semi-imlllune peoples. Defin ing lepromatous leprosy II bacteriologicall y positive, lepl'oillin negn tive, find hi stol ogica ll y with predominAn ce of vacuolated hi stiocytes and lepra cell s, and tubercul oicl leprosy as barteri olog icall y negative, leprom in positi ve, and with tuber culoid structure of the lesions, then there are at ]Pllst 3 lepromatous cases for every tuber culoid case. Furtherm or e, neural in volvement is alm ost invariable in l epromato~ s cases and less prominent in tuber culoid on('s. Cases r egard('d as tuberculoid have, af ter a number of years, become fra nkl y lepromatous, wh('reas lepromatous cases und er treatment have become leprom in positive concul'l'entl y with rApid im provement. Consequentl y, these classifi cations ar e not r ega rded as ha ving any permanency or importance beyond the degree of r esistllnce displayed lit th e tim e of examinati on, and th ere is seen n o u 'e in Rdopting the 'intermediary classificati on whi ch arc useful in other countri es wh ere ra cial immuniti es have given g reater stahility to th e typ e or progress of the disease. Th er e is no suggestion of infant susceptibility. Several cnses in whites have OCCUlTed after brief or cursory exposure, and th e number of them is r emarkably high in view of the fe w at risk and th e opportun ities fo r in fectio n; and the L:T r atio is 2 :1 [No dAta fi re given.] Ther efore, any imlllunity th e white man has is derived largely from hi s sanitary environm ent and is not due to an intrinsic r acial factor. Susceptibility is r ega rded as dep endent on some f actor which, as suggested by lepromin r eactivity or the la ck of it, may not alwa ys be present in th e same individual to th e same degree. Chemotherapy began late in 1947, wh en a fe w patients were put on Dia sone or Promin, a nd various other preparations have heen emp loyed since then. 1'he effects are to be seen in th e leprosarium data, with its decr ease f r om a peak of 333 in 1951 to 150- in spite of the fact that since 1954 all ba cteriologically n ega tive neural cases have been Admitted because of increasing doubts abo ut the noninfectivity of such cases, and in spite of increase of the negative period r equired for discharge f rom 1 to 2 yea rs. Th e lack of improvement of neural lesions under th e sulfones has been discourag ing, but th e outlook is better with Ciba-1906. It is suggested that witb DDS there' may be a low-deg"ee toxicity which i rn.rely noti ced, but is brought out by the contrasting lack of toxicity of Ciba-1906. The effects of th e present thera py are also seen in the attitude of the patients, who no longer hide in th e bush; search by police has therefore been di. continu ed, and the cases ar e . een

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ea rli er. Still another effect is on the help in the lepr osa riulll ; heretofore alm ost all work ha s been by inmates, but now th e older ones, once skilled, a re becomi ng helpl('ss, and the younger ar e not in the place long enough to become skill ed, so the tim1 is soon coming when outside help will be needed. "Such labour can onl y be drawn with any measure of safety frol11 previously discharged pati ents."-II. W. W. CAU.U.ANZA AMAYA , A. E stado actual de III. lepra en E l Sll lvlld or, C.A. [Pr esent status of leprosy in E l Snlvlldo r, C.A. ] Bo!. Soc. cuban a Der-llIato!. y S ifil og. 17 (1960) 84-91. In an article whieh ha s f ully ns much tabular matter as text, the author says that with th e 178 kn own cases, and at least 400 not dia g nosed, there slwul(1 be a commi ssion of 2 or 3 physicians to laun ch the ba sis of an integ rated cnlllpaign. The disease nffects 11 of the 14 departments of the r epubli c, except Chnlatenango, La Union and San Migue!. It is most common in the second and third decades of li fe, more in men than in women (129 :40), and in poor day laborers who live und er (Ieplorable condition s. - II.W.W. LEIK~JR)

D. L. Leprosy in th e Netherlands. Leprosy Rev. 31 (1960) 290-294.

Leprosy has been rare in the Netherlands, but since 1950 the known cases reached 264, and th e estimated total lies between 300 and 350. The patients originate in overseas countri es; the E uropean patients wer e infected overseas. Patients r eceive free trea tment at the dispensari es of the Gastmann Wi chers Foundation in Rotterdam , and a t university clini cs, or by private doctors if th ey prefer, and a 40-bed sa natoriu m of tbe Gastma nn Wichers Foundation is maintained fo r necessa ry institutional care. The Foundation also maintains a lepr osy specialist and a f ull-time nurse-social workel'. Segr ega tion is not compulsory in the Netherlands, for the changes of infection of indigenous inhabitants is not thought to be serious. Because of various environmental fac tors, and because. the entry of immigrants fro lll infecting countries has declin ed, the outl ook is good .- [ From author's summary.] LEIKER) D. L. Epidemiological and immunological surveys in Netherl nnds New Gui nea. Leprosy Rev. 31 (1960) 241-259. The history of lep rosy in Netherlands :N ew Guin ea is described. In many pa rts of the country leprosy has been introduced onl y recently. The disease spread f rom the coast to the interior, and in severnl tribes it wa.s studied f r om its introduction into the community. It was found that in tribes whi ch have lived in r elative i ~l) l at i on un til recently, the disease follows a pattern which does not differ essentially from that described from Nauru, New Caledonia, and parts of Central and West Africa . This epidem iology has the following chara cteristics : (a) The di sease spreads rapidly, and the leprosy ind ex becomes very high . (b) Most eases are of a mild, minor tubercul oid type. (c) Cases ar e found in the majority of the houses in the village. (d) Adults ar e alm ost as susceptible as children. (e) Most of the patients did not ha ve contact with leproma tous case . This epidemiologic picture wa s found only in areas with a low tuberculin index . The differences in tuberculin index between these tribes and coastal tribes with a Illore comlllon epidem iology were highl y signifi ca nt statistically, likewise in the tuber culin index of tuberculoid patients compared with healthy people from the same age group in the same area. The ep id emiology is explain ed by th e hypo thesis that, in peopl e who possess a potentia.l immunity against leprosy, contact with tubercul osis produces an effective immunity, whi ch prevents the development of tuberculoid lep rosy symptoms in lllany people. It is improbable that tuberculosis contact gives any protection in people who possess a potenti al imlllunity against leprosy, contact with tuberculosis patients Illay ac t temporarily as a source of infection, it is possible that the r eduction of the in cidence of tuber culoid cases by tuberculosis conta ct, or by BCG vaccination,

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may also have an indirect effect on the incidence of lepromatous leprosy. The refor e, although BCG vaccination does not guarantee individual protecti on aga inst lepr osy, it seems to be of definite value, especially in highly susceptible co mmuniti es.-[l!~ r o lli author's summ ary. ] CO~ 'l~ EHAS)

F. Diferencias epidemiologicas de Mad rid y Barcelona con las demas provin cills espaiiolas afectadas p orI a lepra. [Epidemiologic differences between Madrid a nd Bar celona with respect to th e r est of tbe p rovin ces in Spa in affected with leprosy. ] Actas Dermo-Sif. 50 (1959) 448-452.

Repl y ing to [l communi cati on f rom V illlnova a nd MOlllfo rt, th e writer admitted thnt there is a similarity in the situati ons in Ma.drid and Bar celona, in th e sense th at both ha ve IlIHDy pa tients coming from the p r ovin ces with high p revalence r ates of lep rosy, because in thei l" attempts to evade health llIea sures they find homes in the suburbs of the big cities, more in BIll"celona than any wh er e else. Th ere are, however, g reat differences hetween Barcelona and Madrid, firstl y, beca use in Madrid they ca n usually detect mo' t of the cases, and the same is true with those who go to Valencia, whereas in Bar celona one can eas ily evade health regulations. Another quite evident difference between the two eities is the fact th at Madrid is not si tuated in an endem ic area, and all of the cases i~ th e p r ovince wher e Madrid is located came f r om oth er sources, whereas Bar celona lies in the eastcrn f ocus of disease. In brief, the sta tisti cs of Madrid and Ba rcelona, as r ega rd s patients f rom other provi nces, will serve to sti mulate adopti on of r egul ations to improve th e surveillance of all pa ti ents, but not to utilize them to indict the entire prophylacti c ca mpaign in Spain, whi ch is now beginning to show decrease of th e incidence, p r evalence anc] infec tious potentiality of leprosy.- J. GUILLEN" MALI,AC) M. J . Aspects of lepr osy control in the Gambia , B.W.A. (A 2-year assessment. ) Leprosy Rev. 31 (1960) 12-18. In Ga mbia, an enclave ill Senegal about 300 mil es long, the pr esent scheme fo r leprosy control is sp onsored by UNI CEF. Af ter two p r evious parti al su rveys it was estim ated that th er e w good, and the ba cteri al index fe ll markedly, viz., 1.6 to 0.6 in one gr oup, 2.0 to O.R in another gr ou.p, 3.5 to 0.8 in a third gr oup . Etisul has a useful and practical part to play, even in outpatient treatment. In regions lik e North ern Nigeria, where the rate of endemicity is high, the rapid deeline under Etisul of the bacterial index of bacillife rous cases is of vital importan ce to th e control of leprosy. With Eti sul , hope begins to appear fo r the satisfactory treatment of the malign fo rms of leprosy such as show intolerance to standard trea tment.-[In part f rom author's summary. ] inpati ent~,

MU KER.JEE, N. and GHOSH, S. Preliminal'y trial of Eti sul in the treatment of leprosy. Leprosy Rev. 3 1 (1960) 275-277. During the 6 months' trial with this drug alone on three active leproma tous cases, under a method which began with a limited inunction over the right arm and for earm, no app reciable im provement was noticed. E tisul alone was unsuccessful in the treatment of these cases.--[ Fl'om authors' summ ary.] TERENC10} J. and T ARABINI} J. La dexametasona en el tl'atamiento de las leprol'l'eacciones. [Dexam etasone in the treatment of lepra reacti ons.] Re~ . L epro!. Fontilles 4 (1959) 665-676. The problems still posed by relapsing and continu ed lepra reaction, called by some authors as " reactional status," and its possible causes are discussed. Ten lepromatous cases (7 men and 3 women) in state of lepra reacti on were studied. They were treated with dexametasone (:Millicorten, Ciba) in max imum doses of 4 mgm. The r esults were exc¢lIent as rega.rds remission of the clinical condition, the drug being co n ~ id ered more active and less toxic than other corticosteroids; like them, it prevented relapses in cases of " reactional status."-F . CON TRERAS TERENCIO} J. Tratamiento de la leprorreaceiones con el dilll etilisop ropilazuleno. [Treatment of lepra reaction with dimeth ylisopropilazulene.] R ev. Lepro!. Fontilles 5 (1960) 37-48. The author has treated 10 lepromatous patients in lepra r eaction with Azulene (AZ-8). In 2 of these cases this drug was associated with 1l10nosemicarbazone of adrenochrome. Th e dosage employed was 100 mgm. parenterally, and 40 to 80 mgm. orally. In 80% of th e cases complete remission of the r eaction was observed, and in the 2 patients with whom Azulene was combined with th e Chromixin the improvement was more rapid. Tolerance in these patients was excell ent.-[From authoIJS summary.] BARBA R UBIO, :M. and P~~REZ SUAREZ} G. EI P-1133 (nial am ide) como tratamiento de la reaccion leprosa. Nota previa . [P-1133 (nialamid e) as treatment of lepra r eaction; Preliminm'y r eport.] :Medicina (:Mexico ) 40 (1960) 145-147. Lepra r eaction is an old problem fo r th e leprologist because of its various etiologic factors, f rom which-and f rom the derm atologic and general disturbances presented- it could be considered as an adaptation disease. The authors divide the condition into (1) frank lep ra r eaction and (2) subclini cal lepra reaction ; and the former is subdivided into (a) acute, (b) subacute, and (e) typhoreaction . The acute

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f rank f orlll is lIlanifested l) y cuta neous and general symptoms of maxim al deg ree; th e subacute fO t'll1 has th e same sy mptoms but in less marked degr ee ; anc1 both have the tenden cy to r eg ress, although both have also the tendency to r eappeal' pcriodically . The typhoreaction is a fra nk lep ra reaction th e sy illptoms of which a re more or less tolerabl e, but whi ch do n ot disap pear, i. c., th e pa ti ent r emains in a constant r eacti onal sb te. On the other hand , subclini ca l lepra r eaction shows only febricul a, algias and slight di sturbances. FrOlIl the fo regoing, it is seen th at to combat this syndrome th ere can be no specifi c drug; brn efi cial are all th e phar maceutrca ls which imp r ove the adllP tation cap acity of the pa ti ent, quieting him down or invigorating him with psychoa nalyptic ch'ugs . Th e authors have studi ed 6 case, of typh oreaction treated with ni alam ide in doses of 50 to 150 Illg m. given 3 tim es dail y for 6 weeks. Physielll exa mil1fl t ion, bl ood scdilli entati on r atf', blood-cell counts, an(l bl ood prcssure we rc determincc1 every 5 da y . Th e first mfl nifestations to disapp ra r were th c cry th ema nodosulll lesions, which hap p ened in all th e ca ses a Ptcr 1 to 1-112 weeks of trcatnl cnt. The temperaturc became norma l in 2 to 3 weeks, exccp t in 1 ea sc with irid ocycli t is with evid ent in fection. Slight euphoria was noted in 2 to 3 ,i'ceks. In 2 c,'1 ses the bl ood pressure decr ell sed with 75 and 150 mgm . doses, but it beca lil e normal IIgain after reducing the dose. Slight gast rointestinal di sturban ces were also obser ved, which disappeared in like mann er on red ucing the dose. In no ca se wa s ther e diminution of th e leu coey te COUJlt or th e blood sed imentation r ate. Alth ough th e number of observed ca ses was smaJl a nd th e tim e of obser vati on limited, the au thors beli eve that niala lliid e in doses of 75 and 100 mg m. dfl il y is useful in th e trcl1 bll ent of typh or eaction in depr esser1 patients who need p sychoa nalyptics and who have n o compli cating infection.- l\I. MALACARA (

COOle) J. Som e II sp ects of reco nstructive surgery in lep rosy. Ea st Af rica n Med. J . 36 (1959) 410-413. Disabilities fo llowing neuritis crip p le many of the 70,000 p ersons with lepr osy in Ugll nda. On e-hll tf of those with hand disability can be adequately ser vcd by p hysiotherapy. Onc-quarter of th e patients need SUJ'gery af ter prelimin al' physiotherapy. One-qu arter ca n hardly be helped because of mutilation. Preoperatilre 'physioth er apy is important Hnd sim ple. Bunn ell's transplanta tion of th e split sublimis ( tendon has been IIiOSt used. Bra nd's operati on is easier and g-ives good r esults. Attempts to activate the thUJllb al'C always worthwhile. Arthrod esis of' phalanges Illa y be necessa ry; but requires longer imm obilizati on. Op erations on th e hands should be done by a sp eciali st, and often in sta ges. In the foo t, excision of trophic ul cers, sequ estrectomy, r est a nd elevation secure healing'. Grafting is If'sS satisfacto ry than healing f r om the edge of the ul cer. Foot-drop Jlla y be correcteel by tendon transfe rs, or subtal oid arthrodes is, th e Lambrinudi f usion being prefe rred. P olyv inyl chloride molded to the f oot makes a good insole fo r a shoe.--J OlIN GARROD MARTl NS, M. G., FrLlIO. Contribui cubcutnneously dail y fo l' ::l llIonths f rom th e 3rd month after infrctioll , with th ose of 5 unt/'eaten rats showrd th at the total number of bacilli 1)('1' mg lll . of lepl'oma in th e trentrd g l'oup wa s 1/ 10th to 1/ 100th of that of the ('ontrol g roup , and th e proportion of g rcen ( i.r., living) bacilli r anged f rom 6 to 60 % in th e trea ted group [md f rom 88 to 96 % in thr contJ'ol gr oup . The weights of th e lep l'oma. of th e untreated rats r angerl f r om 400 to 730 mgm ., aver age 574 mg m., and th ose of th e tJ'eated r a ts f rom 10 to 630 mg m., ave rnge 206 mgm. Thi s method of stain ing is ther efo re l'eO'ard ed as of valu e fO l' comparing the therapeutic va lue of dru O's 0 1' vaccines in this infect ion . [Deta ils of th e stain ing meth od and the calcul ation fo r estimating th e number of bacilli presen t in th e hOlllogenates, f rom the number of bftcilli p el' micr oscope fi eld, ar e give n. ]- [Frolll ahstl'act by S. R. M. Bu. hby in 1'1·Op . Dis. Bull. 57 (1960) 603-604.] PERfASWAJlIY) ·W. Differentiati on of tuberculoid reaction, bord el'lin e nnd lpp l'omatous cases bacteriologica lly. Leprosy in Indi a 31 (1959) 103-106. Three typ es of leprosy lesions, tuberculoid in reaction, borderline, nnd in filtrative lepr omatous may sometimes r esembl e each other. From 10 such cases smea rs were taken f r om (a) apparentl y normal skin, (b) periphery of th e lesion, and ( c) about 3 mm. out id e th e peri phery. All smears were positive in th e 4 cases diag nosed as lepr omntous but were nega tive in th e normal skin of th e 6 oth er s. Of th em, all positive at the periph ery of th e lesions, 2 were nega tive a little away, and these wpre diag nosed as tubercul oid. All diag noses were confirmed histologica lly. [Ten cases is a very small 1lUmber with whi ch to establish such a differential procedure, but the suggestion is inter esting.]-H. W. W. W Af,LACE) J. H. and HA NKS) J. H . Agar substrates for stud y of microepidemiology and p hysiology in cells in vitro. Science 128 (1958) 658-659. CeJ'tnin shortcomiJ1gs of monolayer cell and ti ssue cultures when used in th e stud y of infectious rli sense can be overcome by using agar substrates. Co nlbina tions of infectious agents with cells or cell coloni es on agar provide a contiguity of cells closel: th a n in an imal tissues ; extracellular inhibitors a re of less concel'll ; neither th e agent 11 01' the cells can pscape th e experimental ar ena . This is an advantage in the study of microepidem iology and cell physiology, and, at the same time, p ermits the maintenance of cell cultures for extend ed p eriods with minimal care. S ubstrates are prepared by combining, at 50°C, double-strength nutriments with equal volum es of 2 to 4 % purified agar in BSS just prior to preparation of p lates and slan ts. A third form of substrate is prepared by impregnating filter paper (pr eviously extracted twice with boiling di still ed water) with the agar mixture. Reservoirs of renewable, slowly available liquid nutrim ents ar e made possibl e by filling cup-like wells in the aga r in p late preparations or by adding smnll amounts of media to the slants and filter p aper prep arations in the vertical position, limiting the contact of liquid to a small area of the substrate. Cells can be removed quantitatively by application of pancreatin. Ti ssue fragments (bone marow, embryonic chick, embryoni c human) can also be studi ed in these systems. Data and references to media composition and cultivation techn\ques ar e given.- J. A. ROBERTSEN BROWN) J. A. K . and REES) R. J . W . A simple apparatus for the transport of leprosy tissue on ice. East African Med . J . 36 (1959) 495-499.

Cnn'cnt Litcrat ure

29, 2

259

The appa r atus, lIescJ'ibed with two photog raphs, consists essentially of a vacu um fla sk insertcd in a canvas bag, suspend ed on sp rings in a light wooden crate. A pecial p lastic cartr idge hold s one large 0 1' two slllall screw-capped bottles. The cartridge is charged with the material to be transported, and then placed in the thermos fla sk with ice. Thp ca I't l'idge provides protection against leakage or contamination of the tissue.JOH N GARROD

BOOK REVIEWS Notes

Lep'·osy. By DHARMENDRA J M.B.B.S ., D.B. (Lond.) , D irecto r, Central Leprosy Tefl ching a nd Researc h Institute, Chingleput, Madras. New Delhi: Mini stry of Health, Govel'l1m ent of India, 1960. Pp. vi + 203, with 283 f igs. and 47 p lates. (Obtainable from th e Institute at Cbing leput, price Rs 8/ -.) Thi s book, based on the notes of th e auth or's trai11ing courses, constitutes a consider a bl e and va luable contribution. Nevertheless, it is expected to be fo ll owed by a more compl'eJlf>nsive textbook- for which rea soll, it is exp lain ed, this one conta ins no referen ces to the literature . Heganlillg th e hi ~ tol'y of .l eprosy, the disea se is of great anti qu ity of uncertain orig in, with perh fl ps th e oldest dennite references ascribable to India. Distributio n is also dealt \I'ith briefly, with the rough estimate of 5 mi llions- a wel com e change fr om the us ual 10 milli ons 01' llIor e from sources interested in impressive numbers. Th ere is it world map of distribution, which- as usual-shows endemicity in certain countries where only imported ra ses are to be f ound. With something of understatement it is said that "it is now generally believed that leprosy is an infect ive disease caused by My cobactm'ium Ze pme/ ' alth ough it has not been possib le to prove its r elationshi p scientifica lly. After what is proper ly call ed a " la tent" period, the symptom s of onset a rc very varia ble, but the establi shed disea se is of two main fo rl11s, "benign" and "malign," the differences du e to differences of r esistan ce of the infected indi vid uals. F oll owing the Indian Association . ystem of classifi cation there arc, besides the leproDw tous c.l ass, the nonlepromatous one which is divided into tuberculoid, maculoanesthetic, an d polyneuritic f orms, a nd t he so-ca ll ed intermediate cla ss divided into ind etel'lliinate (with flat patches) and bordel'lin e (with thick patches ). The di\'ision of the tuberculoid typ e into minor and major is done secondari ly, the distingui shing features being the extent and degree of thickening of the lesions. There is no mention of th e development of " loca l immunity" which is exhibited under certai n conditi ons in sites of he,ll ed major tuberculoi d lesions. The polyneuritic f orlll would be morC' clearly understood if, as th e Ca iro congl'es. intended, it were confined to cases with onl y nerve-trunk in volvement, without associated skin lesions (i.e., the "p ure and prilliary polyneuriti c t~l pe"). Th e clinical description of the lepr omatous for ll1 is quite acceptable ; the diffuse variety of this type as seen in India is not com mon, if ind eed encountered at all, in other countries. Th at of the borderli ne condition is also good, in the main, esp ecially the statement that the differentiation of the lepromatou. and borderlin e lesions "w ill depend much on the concept and experience of individual workers." Nothing is sa id, however, of its usual origin as a l'eactiona l deterioration of tuberculoid leprosy. 'fh e ind eterm in ate fOl'm is well described as ca ses n ot satisfactorily diagno ed fl S maeuloa nestheti c or lep romatous, fi nd of un certain evolu tion. 011