Studies upon leprosy. IV. Upon the utility of the examination of the nose and the nasal secretions for the detection of incipient cases of leprosy / by Walter R. Brinckerhoff and W.L. Moore.

  • Brinckerhoff, Walter Remson, 1874-1911.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Studies upon leprosy. IV. Upon the utility of the examination of the nose and the nasal secretions for the detection of incipient cases of leprosy / by Walter R. Brinckerhoff and W.L. Moore. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    In the inspection of the nasal septa no suspicious pathological con- ditions were found. In the bacteriological examination of the nasal secretions one case of clinically certain phthisis showed acid-fast bacilli in the smear. The case did not come under observation again, but the subsequent history was that of a rapidly fatal pulmonary tuberculosis with frequent profuse hemorrhages. Although it was not possible to make a thorough study of the case, we feel justified in regarding it as not leprous in character. In two instances the conditions warrant the detailed presentation of the case, as follows: 1. H. M . Portuguese; age, 11 years; born in Hawaii. This boy was suspected of being a leper by the physician in charge of school inspections. He was brought to the dispensary for an official examination. The case was clinically one of tubercular leprosy in a moderately early stage. Smears of the nasal secretion taken at the time of the official examination showed no acid-fast bacilli. The bacilli of leprosy were easily demonstrated in a bit of tissue excised from the skin. The two brothers of the leper were examined at the same time, and one of them was regarded as a suspect. Unfor- tunately the two brothers were concealed by the parents, and no further studies could be made of their cases. Smears taken from their nasal secretion at the time of the first examination showed no acid-fast bacilli. The boy who was officially declared a leper was seen by one of us (W. E,. B.) on two occasions at the Kalihi receiv- ing station. Each time a careful inspection of the septum failed to reveal any pathological condition, and smears from the nasal secre- tion were negative. The final examination of the nose was made five weeks after the official examination. 2. H. B . Hawaiian; age, 25 years; female. The septum shows much thickening of the mucous membrane over the carti- laginous portion of the right side. The mucous membrane is rough and of an opaque white color. Smears made from material obtained by a vigorous swabbing of the right side of the septum with a sterile cotton swab. No physical examination was made. Microscopic examination.—Two smears examined. A moderate number of slender, not beaded, acid-fast bacilli are present. The bacilli are often curved. Three typical bacillary heaps are found. The bacilli agree with the Bacillus leprce in morpholog}, arrangement, and staining reaction. This case passed from observation for a time, as it was not con- sidered expedient to apprehend her as a leper suspect for political reasons. Summary of the results of examinations of patients at the Free Dispensary.^ Honolulu.—Among the 46 Hawaiians examined, 1 case