In Nepal, the setting up and maintaining of reliable services for slit skin smears has proven difficult. A clinical classification system for leprosy has therefore been developed to assist in the allocation of patients to either paucibacillary or multibacillary groups for the purposes ofmulhple drug therapy (MDT), using 9 body areas: head (I), arms (2), legs (2), trunk (4). Patients with more than two areas of the body affected are grouped as multibilcillary (MB) and those with only one or two areas affected are paucibacillary (PB). Using a computer simulation model and the data of 53 patients registered at Green Pastures Hospital (GPH) in Pokhara and 703 field patients from the Western Region, different clinical classification systems were evaluated with regard to their sensitivity, specificity, and predictive value for MB or PB classification, as compared with the histological classification for the GPH cases and the bacteriological classification for the field patients. The sensitivity and specificity of the body area system in present use were 93% and 39%, respectively. The low specificity is due to MB overclassification. The sensitivity of the WHO classifica tion system without skin smear facilities is 73% (the difference with the body area system is significant: p < 0•05, McNemar's test). Our histology findings confirm previous publications indicating that, while some borderline-tuberculoid (BT) patients may outwardly have a 'PB appearance' and be skin-smear negative, their nerve biopsy and sometimes skin biopsy may show a 'MB' picture. This is the first publication discussing a 'body area system' for the purpose described, including diagrams of the areas used. In Nepal it has proved easy to use and teach and its use may be justified in other control programmes which implement MDT, particu larly if slit-skin smear services are unreliable or nonexistant.

To determine the magnitude of eye lesions in newly diagnosed leprosy patients we examined their eyes. The Eastern Leprosy Control Project was supported by The Netherlands Leprosy Relief Association; we used the regional clinic in Biratnagar and 5 mobile clinics in surrounding districts as our survey area. All patients who presented at the clinics over 10 weeks, diagnosed as having untreated leprosy were included. Of the 260 examined patients 97 (37,3%, 95% confidence interval 28,3-40'3%) had an eye lesion; 12/260 patients (4'6%, 95% confidence interval 2,0-7'2%) had sight-threatening lesions (lagophthalmos, iris involvement, corneal anaesthesia), directly related to leprosy; 46 (17,7%) patients were diagnosed as having some degree of cataract; 2 patients were aphakic; 3 patients (1'2%) were blind according to the WHO definition. In this series of new and untreated leprosy patients many eye lesions found are not relevant or leprosy related. There were 9 new patients with lagophthal mos, some too longstanding to treat with steroids. We found 3 patients with iris involvement. The figures we found for eye lesions, sight-threatening lesions and blindness are low when compared to other studies. The number of patients with any grade of cataract is high. The average total of leprosy patients who were blind can be compared with the average total who are blind in the general population.

The objective of the study was to determine the magnitude of hand/ fe et/eye disabilities in newly diagnosed leprosy patients by examining all newly diagnosed leprosy patients who presented at the Eastern Leprosy Control Project (supported by The Netherlands Leprosy Relief Association), made up of a regional clinic in Biratnagar and 5 mobile clinics in surrounding districts.The study comprised of all new and previously untreated patients who presented at the clinics over a 10-week period who were diagnosed as leprosy sufferers.Of the 260 leprosy patients examined 12 (4'6%) had sight-threatening lesions (lagophthalmos, iris involvement, corneal anaesthesia); 3 patients were blind due to cataract; 96/260 patients (37'0%, 95% confidence interval 35'0-43'0%) had I or more disabilities of their hands and/or fe et. The most frequently found disabilities were sensory loss of the hands and feet, claw hand and plantar ulcers. According to the WHO disability grading 60% had no disabilities, 19% had grade 1 and 21 % had grade 2 disability.Disability assessment is very important not only to evaluate the effectiveness of the control programme but also for the patient, whose most important worry is the stigmatizing deformities leprosy patients suffer. The earlier detection of sensory loss might reduce these secondary deformities.

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CORRESPONDENCE MEDICAL JOURNALOwing to the fact that w-e were dealing with African natives we had to rely upon examination of the conjunctivae for the presence of petechiae. Of the whole series, 78 (45%) presented this sign, many of them before meningism supervened. These latter suffered, as Drs. Turner and Dent describe, from collapse associated with rise of temperature and rapid feeble pulse ; a number of them also had loose incontinent stools, which was a bad prognostic sign. Penicillin was not yet available, and I was unaware of the value of adrenal cortical extract, but all cases were immediately put on sulphonamide as a routine. There were 25 deaths (14.5%O) in all-21 of the patients dying on the day of admission.The mortality rate threw some light on the value of petechiae as a prognostic sign. The figures for this series were total number of cases with petechiae 78, deaths 25 (320%); total number where no petechiae were observed (all verified cases by lumbar puncture) 95, deaths ni/.It may be of interest to mention that two cases in the series had persistent meningism with turbid C.S.F. for several weeks. Both cases made uneventful recoveries soon after the intravenous injection of T.A.B. (100 million), followed by a 200-million dose two days later.-I am, etc., Kirkby-in-Ashfield, Notts.