cornea on the pupillary side of the lesion; it is found that the bacilli do not traverse the cicatrix. Tarsorrhaphy for ectropion of the lower lid; iridectomy for iritis, or synechiæ; tracheotomy for laryngeal stenosis; and necrotomy for bone disease, may sometimes have to be performed. Horder strongly recommends amputation for perforating or other forms of ulceration; the general health is much improved by the removal of such sources of sepsis. The existence of leprosy does not materially interfere with the success of surgical operations. I once removed an enormous elephantiasis of the scrotum from a confirmed leper; the presence of the leprosy did not prevent sound healing of the extensive operation wound, the man making a good recovery so far as the operation was concerned.
If only one tubercle or one limited lepra macula is present, and there have been no constitutional signs of a general invasion, it is advisable to excise freely the affected spot.
What promised at one time to prove an important advance in the therapeutics of leprosy is the method introduced by Prof. Deycke under the name of nastin treatment.
Prof. Deycke obtained from a case of nodular leprosy a peculiar acid-fast bacterium— Streptothrix leproides— resembling in many respects Bacillus leprce, but differing from the latter inasmuch as it could be readily cultivated. In unskimmed milk it forms a brilliant orange-red pellicle, which on digestion with ether yields a fatty substance— "nastin"— of definite chemical character. Injections of pure nastin in oily solution give rise in some lepers to inflammatory reaction of varying degrees of intensity— it may be violent; in other lepers again no such reaction occurs. Concurrently with reaction there is pronounced bacteriolysis and disappearance of the lepra bacilli as evidenced by their losing their staining reactions and by their disintegration. Several patients treated in this way improved, some apparently recovering; but the uncertainty as to whether in any given case reaction might not prove of so
