"4. Leprosy is not directly originated by the use of any particular article of food, nor by any climatic or telluric conditions, nor by insanitary surroundings, neither does it peculiarly affect any race or caste.
"5. Leprosy is indirectly influenced by insanitary surroundings, such as poverty, bad food, or deficient drainage or ventilation, for these by causing a predisposition increase the susceptibility of the individual to the disease.
"6. Leprosy, in the great majority of cases, originates de novo, that is, from a sequence or concurrence of causes and conditions dealt with in the Report, and which are related to each other in ways at present imperfectly known."
The practical suggestions of the Commission for preventive treatment included voluntary isolation, prohibition of the sale of articles of food by lepers, leper farms, orphanages, and "improved sanitation and good dietetic conditions" generally. Serum-therapy has been attempted on behalf of the French Academy of Medicine, but without success. Many forms of treatment ameliorate the miserable condition of the leper, but up to the present no curative agent has been found.
Diplococcus of Pneumonia
Pneumonia. Some of the difficulty which has surrounded the bacteriology of inflammation of the lungs is due to the confusion arising from supposing that attacks of the disease differed only in degree. Pneumonia, however, has various forms, arising now from one cause, now from another. The specific or croupous pneumonia is associated with two organisms: Fraenkel's diplococcus and Friedländer's pneumo-bacillus. Several other bacteria have from time to time been held responsible for pneumonia, a streptococcus receiving, at one time, some support. But whilst opinion is divided on the rôle of various extraneous and concomitant bacteria in lung disease, importance is attached to Fraenkel's and Friedländer's organisms.
The diplococcus of Fraenkel is a small, oval diplococcus found in the "rusty" sputum of croupous pneumonia. It is non-motile, non-liquefying, and aërobic. When examined from cultures the diplococci are frequently seen in chains, not unlike a streptococcus, and there is some reason to suppose that this form gave rise to the belief that it was another species; when examined from the tissues it possesses a capsule, but in culture this is lost. It is difficult to cultivate, but grows on glycerine agar and blood serum at blood-heat. On ordinary gelatine at room temperature it does not grow, or, if so, very slightly. The ideal fluid is a slightly alkaline liquid medium, and in twenty-four hours a powdery growth will occur in such broth. On potato there is apparently no growth. It rapidly loses its virulence on solid media, and is said to be non-virulent after three or four sub-culturings. A temperature of 54–58° C. for a few minutes kills the bacteria, but not the toxin. This, however, is removed by filtration, and is therefore probably intracellular. It is attenuated by heating to 70° C.
Fraenkel's diplococcus occurs, then, in the acute stage of pneumonia, in company with streptococci and staphylococci. It also occurs in the blood in certain suppurative conditions, in pleurisy and inflammation of the pericardium, and sometimes in diphtheria, and therefore it is not peculiar to pneumonia.
There is one other point to which attention should be drawn. Fraenkel's organism is said to be frequently present in the saliva of healthy persons. Pneumonia depresses the resistant vitality of the tissues, and thus affords to the diplococcus present in the saliva an excellent nidus for its growth.