Bassett-Smith recommends an autogenous vaccine, during the afebrile period, in doses of from 50 to 200 millions. He thinks that the best results are obtained with sensitized vaccines. During acute phases the vaccine treatment is detrimental—it is only in chronic cases that such treatment is of value. Some prefer to give doses of 10 million or so at short intervals. He also thinks yeast in 2-dram doses to be of value. Phenacetin or aspirin may be given, but the heart weakness makes extensive use of these analgesics dangerous. The diet should be that for any acute disease but the protracted course makes it necessary to have regard to an adequate food value. Care should be taken to avoid chilling or fatigue. Some recommend moderate use of alcoholic stimulation but this treatment is questionable. Cold sponging and local applications to joint or nerve involvements are indicated. Morphine should be employed with great caution. CHAPTER XVII LEPROSY DEFINITION AND SYNONYMS =Definition.=—Leprosy is a very chronic, almost incurable disease, with a protracted period of incubation (two to ten years), which sets in with indefinite prodromata of malaise, and irregular febrile attacks associated with sweating and somnolence. In nerve leprosy there may be vague manifestations of neuritis as prodromata. There are two well-recognized types of the disease. The type characterized by granulomatous proliferations in corium and subcutaneous tissues, as well as lymphatic glands, is known as nodular or skin leprosy. It shows spots and nodular infiltrations, chiefly about lobes of ears, alae of nose and region of eyebrows, with falling out of hairs of eyebrows and bearded region, and also involves extensor surfaces of forearms, dorsal surfaces of hands and feet. The palms of hands and soles of feet are almost never invaded. The other type is known as nerve or maculo-anaesthetic leprosy and is characterized by nerve thickenings, flat anaesthetic spots, chiefly of the covered region of the body, muscular palsies and atrophies, with trophic changes leading to contractures and mutilations. When the two types are associated we have mixed leprosy. The disease is caused by an acid-fast bacillus, which has not surely been cultivated or inoculated into animals with pathogenic result, and which is found in extraordinary abundance in the granulomatous subepithelial tissues of nodular leprosy and in scanty numbers or not at all in the perineurium and endoneurium of the ulnar, facial or perineal nerves. =Synonyms.=—Lepra. Elephantiasis Graecorum. Leontiasis. Satyriasis. French: La Lèpre. German: Aussatz. HISTORY AND GEOGRAPHICAL DISTRIBUTION =History.=—There are those who consider India as the home of leprosy, a condition corresponding to the disease having been described in the Rig Veda, of date of 1400, B. C.