14 The Philippine Journal of Science 
Plate III, fig. 21, illustrates the typical, sluggish, neurotrophic 
ulcers, which although almost incurable appear to have a strong 
resistance to the ordinary pyogenic infections. Here, too, is 
shown the curious parchmentlike skin frequently seen among 
anesthetic lepers. 
The macules of the maculo-anesthetic type are reproduced 
with difficulty, particularly in the dark-skinned races, because 
of the lack of contrast (Plate III, figs. 22 to 25). 
Another lesion of leprosy that, due to its great prevalence 
among the Filipino lepers, deserves special description is the 
condition of bone necrosis and absorption commonly seen in the 
feet and hands. The condition is generally described as of the 
maculo-anesthetic type and is probably not entitled to classifi- 
cation as a special type. The condition may be seen rarely 
among the pure nodular types, commonly among the maculo- 
anesthetic and mixed types, and occasionally among lepers who 
fail to show coincident evidence of progressive nodular or maculo- 
anesthetic symptoms. The complete series of changes exterids 
over a number of years and therefore may be followed with 
great difficulty in individual cases. The sequence appears to 
be much as shown in Plate IV, figs. 26 to 38. 
The process of absorption as indicated above usually does not 
continue without complications from trauma and secondary in- 
fections; the bones being near the surface and unprotected by 
the normal connective tissue pads of the finger tips, sinuses 
frequently form, from which necrotic bone is discharged. An 
instance is recalled of a patient, since dead, in whom the five 
finger nails of one hand remained attached in a much distorted 
condition at the site of the radiocarpal articulation, the bones 
of the entire hand having been absorbed without rupture of 
the skin from trauma. 
It is not to be inferred from this series of photographs that 
each case of leprosy progresses by rule to a definite classical 
physical picture; there is perhaps no disease so capricious in 
the manifestations of its clinical progress. 
