CIHM Microfiche Series (l\Aonographs) ICMH Collection de microfiches (monographies) Canadian Institute for Historical Microreproductlons / Institut canadien de microreproductions historiques Technical and Bibliographic Notes / Notes techniques et bibliographiques The Institute has attempted to obtain the best original copy available for filming. Features of this copy which may be bibliographically unique, which may alter any of the images in the reproduction, or which may significantly change the usual method of filming are checked below. Coloured covers / Couverture de couleur Covers damaged / Couverture endommag6e Covers restored and/or laminated / Couverture restauree et/ou peiiicul^e Cover title missing / Le titre de couverture manque Coloured maps / Cartes g^ographiques en couleur Coloured ink (i.e. other than blue or black) / Encre de couleur (i.e. autre que bleue ou noire) Coloured plates and/or illustrations / Planches et/ou illustrations en couleur Bound with other material / Reli6 avec d'autres documents Only edition available / Seule edition disponible n □ n Tight binding may cause shadows or distortion along -I interior margin / La reliure serree peut causer de I'ombre ou de la distorsion le long de la marge interieure. D Blank leaves added during restorations may appear within the text. Whenever possible, these have been omitted from filming / Use peut que certaines pages blanches ajoutees lors d'une restauration apparaissent dans le texte, mais, lorsque cela etait possible, ces pages n'ont pas ete filmees. Additional comments / Commentaires supplementaires: L'Institut a microfilme le meilleur exemplaire qu'il lui a ete possible de se procurer. Les details de cet exem- plaire qui sont peut-etre uniques du point de vue bibli- ographique, qui peuvent modifier une image reproduite, ou qui peuvent exiger une modification dans la m6tho- de normale de filmage sont indiqu6s ci-dessous. Coloured pages / Pages de couleur I I Pages damaged / Pages endommagees D D D n Pages rpstored and/or laminated / Pages restaur6es et/ou pellicul^es Q Pages discoloured, stained or foxed / Pages ddcolor^es, tachet^es ou piqu^es Pages detached / Pages detachees y\ Showthrough / Transparence I I Quality of print varies / Quality in^gale de I'impression Includes supplementary material / Comprend du materiel suppl6mentaire Pages wholly or partially obscured by errata slips, tissues, etc.. have been refilmed to ensure the best possible image / Les pages totalement ou partiellement obscurcies par un feuiliet d'errata, une pelure, etc., ont 6t6 filmees a nouveau de fafon a obtenir la meilleure image possible. Opposing pages with varying colouration or discolourations are filmed twice to ensure the best possible image / Les pages s'opposant ayant des colorations variables ou des decolorations sont filmees deux fois afin d'obtenir la meilleure image possible. This item is filmed at the reduction ratio checKed below / Ce document est filme au taux de reduction indique ci-dessous. 10x 14x 18x 22x 26x 30x 12x 16x 20x 24x 28x 32x The copy filmed hare has b««n raproducad thanks to tha ganarosity of: Osier Library, McGill University, Montreal Tha imagas appearing hara ara tha bast quality possible considering the condition and legibility of the original copy and in keeping with the filming contract apacificationa. Original copies in printed paper covers are filmed beginning with the front cover and ending on the last page with a printed or illustrated impres- sion, or the back cover when appropriate. All other original copies ara filmed beginning on tha first page with a printed or illustrated imprea- sion, and ending on the laat page with a printed or illustrated impression. The last recorded frame on each microfiche shall contain tha symbol — ^ (meaning "CON- TINUED"), o' the symbol ▼ (meaning "END"), whichever applies. Maps, plates, charts, etc.. may be filmed at different reduction ratios. Those too large to be entirely included in one exposure are filmed beginnir.g in the upper left hand corner, left to right and top to bottom, as many frames as required. The following diagrams illustrate the method: 1 2 3 1 2 4 5 L'axemplajra filmi fut reproduit grica i la gAnArositA de: Osier Library, McGil! University, Montreal Le* images suivantes ont it^ reproduites avec le plus grand soin. compta tenu da la condition at da la nanetA da raxamplaira film^, at an conformiti avac laa conditions du contrat de filmaga. Lea exemplairas originaux dont la couvarture an papier est imprimAe sont filmis en commenqant par le premier plat at en terminant soit par la derniire page qui comporte une emprainte d'impressicn ou d'illustration, soit par le second plat, salon le cas. Tous las autres exemplairas originaux sont filmis en commenpant par la pramiAre page qui comporte une empreinte d'impression ou d'illustration at en terminant par la derniAre page qui comporte une *elle empreinte. Un des symboles suivants apparaitra sur la derniire image de cheque microfiche, selon le cas: le symbole ^^ signifie "A SUIVRE", le symbole V signifie "FIN". Les cartes, planches, tableaux, etc., pauvnnt etre filmAs d des taux de reduction diffirents. Lorsque le document est trop grand pour fttre reproduit en un seul cliche, il est filmA d partir de Tangle sup^rieur gauche, de gauche A droite, et de haut en bas, en prenant le nombre d'images nicessaire. Les diagrammes suivants illustrent la m^thode. 2 3 5 6 MICROCOPY RESOIUTION TEST CHART ANSI and ISO TEST CHART No 2- ^ APPLIED IN4/IGE Inc '■3;-'(?stef, Ne,» 'Qrk '4609 ■ '5; ''82 - OZOO - Phone "61 288 - 5989 - Ta- c, 44XvKi ^"^ Z, NOTE OX A RAPID METHOD OF DIAGNOSIS IN LEPROSY. Bv Francis J. Shepherd, M.D., ok Montreai Read before the twenty-seventh annual meeting of the American Dermatological Association, Washington. D. C, May 12, 13 and 14, 1903 Reprinted from The Journal of Cutaneous Diseases for October, 1903. THE GRAFTOxN PRESS PUBLISHERS 70 FIFTH AVENUE NEW VORK Copyright tgo2 hy The Grafton Press NOTE ON A RAPID METHOD OF DIAGNOSIS IN LEPROSV. By Francis J. Shepiieed, M.D., or Montseal. Read before the twenty-seventh annual meeting of the American Dermatological Association, Washington, 1). C, May 13, 13 and 14, 19(W. CASE: The patient, a Cliimse Inunclrvmun, at. 19, naiiiotl Hum Sam, was admitted into the Montreal General Hospital, April 17, 1902. He left China two years ago and has lived in Montreal ever since. Until September, 1901, was quite well. At this time there was redness and thickening of the skin on the forehead. This was soon followed by erythematous patches on the arms. This eruption was very itchy ; was much worse in wann weather and cold seemed to improve it. From thence it extended over the botly. The patient is a well-made young man, of fair intelligence. On the forehead are seen reddened areas of thickened skin from the size of a 20-cent piece to a 50-cent piece. Some of these patches arc fused together; there are also similar patches on the face, on cheeks and temples. These patches are not painful, but arc very itchy at times. On the arms, especially on the exterior surfaces of the ellwws, arc round and oval areas, covered with small whitish scales. The scales are more at the margins of these patches, the center being of smoother appearance and brownish yellow in color. These areas are (listinctly aniesthctic, some more so than others. Similar patches are seen on the trunk and legs, but these are not so numerous as on the arms. The patches are raii^cd above the surrounding skin and are all covered with branny scales of a yellow-brown color. They arc cs- pecialh' well marked on the buttocks, where they have somewhat the appearance of an old psoriasis. Both external jugular veins arc easily felt, and seem to have much thickened walls, which make them feel like cords. There is no tender- ness on pressure. The glands in the posterior cervical triangle be- hind the sterno-mastoid are much enlarged. The inguinal and epi- trochlcar glands arc increased in size. The hands are perfectly free from nodules and are apparently normal. Both ulnar nerves behind the elbow are distinctly thickened and nodular, especially on the left side. The nniscuIo-sj)irnl nerve Is also slightly enlarged. There is also some enlargement of the external popliteal nerves at the knee joints. It was very difficult to get any information out of the patient, even through an interpreter, chiefly because it was not given willing! v, 1 8 OUKWNAI, (OMMIMCATIONS. 1 1 ^va^ iinportiiiit to make an accunitf (liaj;iu»is, as tlit- city aiitlxiri- tif> uiNlu'd to liavf tlir man M'nt hack to China it" the fasi- wiTi- posi- tivtlv oni' of Irprosy. thf Canadian I'acitic KaiUay liuvinj; a/^rttd to tiansport him trcf ot" cliarg*'. So I tlcciilid, to make the dia^noslH Miif, to tut down and ninovi- a portion of oni' of th»' uhiar niTvis. 'I'liis was doni' and a lUMlulf nrnovid. Dr. .1. .MrCrat-, our Patliolo- j^ist, txaminrd the no