Isle of Pines.— Similarly, in the Isle of Pines leprosy was introduced in 1878, and has since spread. In the Loyalty Islands the first case was seen in 1882; in 1888, in the island of Mare alone, there were 70 lepers.
Symptoms.— Although, as will "afterwards be explained, the Bacillus leprœ is the cause of all leprosy, the clinical manifestations of its presence are far from being identical in every case; indeed, they are almost as varied as are those of syphilis or of tubercle. Our early conceptions of the disease, derived for the most part from the Bible or poetical literature, in which the leper is symbolical of all that is loathsome and hopeless, are apt to mislead. As a matter of fact, in its earlier stages leprosy is far from being always, or even generally, a striking disease. Often for years the only visible evidence of its existence may be two or three small blotches, or perhaps one or two patches of pale or pigmented skin on trunk or limbs— very likely concealed by the clothes and perhaps disregarded by the patient himself— the true significance and nature of which can be appreciated only by the expert. It is generally not until the later stages that we see the disfiguring and extensive lesions on which the popular conception is founded. As a rule, leprosy is a disease of very slow development. Sometimes, it is true, it is suddenly and frankly declared from the outset, and progresses rapidly; but in the vast majority of cases the early lesions are trifling and are apt to be misinterpreted and overlooked, and years elapse before serious mutilation or deformity is produced. The student must bear this important practical fact in mind in the study and diagnosis of all equivocal skin lesions in persons residing in or coming from the endemic haunts of leprosy.
To facilitate description, it seems advisable to divide the evolution of leprosy into stages, premising, however, that the division proposed is in great measure an artificial one. What are here designated stages are not, all of them, clinically and in every instance, abruptly separated or even present; for the
