The luetin reaction is negative in leprosy.
Mycosis fungoides has not the characteristic location about the face and itches markedly and does not show anaesthesia.
Vitiligo shows an abrupt margin and is not anaesthetic.
Laboratory Diagnosis.—The usual procedure is to scrape a spot or nodule with a scalpel until the epidermis has been gone through and then smear out the serous exudate on a slide and stain by the Ziehl-Neelsen acid-fast method or by Gram’s stain. Twenty per cent. sulphuric acid is less apt to decolorize than the 3% acid alcohol, the leprosy bacilli being less resistant to acid alcohol decolorization than to aqueous acid solutions. There is a great variation in the resistance to decolorization of leprosy bacilli, a preparation from one case holding its color almost as well as tubercle bacilli, while material from another case may decolorize very easily.
I am partial to Tschernogabow’s technique. In this, one punctures the subepithelial granulomatous tissue with a capillary pipette, the end of which has been broken off by tapping the point in order to give a cutting point, and the serum which exudes is smeared out and stained.
Some prefer emulsifying a piece of the tissue and centrifuging and staining the sediment. Quite recently the antiformin method of treating leprous tissue, as for tuberculous tissue, has been used.
Many insist that the best method is to cut out small sections of the lesion, going well into normal tissue, and putting through paraffin and cutting thin sections and staining. Gram’s method, counterstaining with bismarck brown, gives beautiful preparations. For acid-fast staining first stain with haematoxylin to obtain a histological background and then steam with carbol fuchsin, decolorize very briefly with acid alcohol, then through absolute alcohol and xylol.
Of the greatest diagnostic value is the staining of the nasal mucus or scrapings from ulcerations on nasal septum for leprosy bacilli. These are often found in the characteristic cigar package bundles or engulfed in lepra cells. A standard procedure is to give 60 grains of iodide of potash to cause a drug coryza, in the secretions of which leprosy bacilli may be found. However, one will have better success if the nasal secretion be obtained at a time when a natural coryza exists.
Thibault examined the nasal mucus, gland juice and blood of 30 lepers. He obtained leprosy bacilli in the nasal mucus of 20, in the gland puncture juice of 18, and in the blood of 7.