1923- ^*''^• 1 6. THE NEL'ROI.Or.ICAL ASPECT OF LEPROSY. 



Vasomotor, Secretory, and Trophic Disturbances. 



These have been described so often and so well that I can be very 

 brief in this chapter. 



In hardly any other disease do we find trophic disturbances so fre- 

 quenth'. They appear in a great many difterent forms. They are all consid- 

 ered to be of nervous origin — neurotrophic disturbances — although a 

 more intimate knowledge of the pathogenesis is still lacking. 



1. We find vasoniofor (disturbances, as in any other lesion of the 

 peripheral motor neuron, e. g. poliomyelitis, — clinically betraying themselves 

 by coldness and cyanosis of the affected parts — chiefly hands and feet. 



2. Anidrosis is frequently seen in the anaesthetic areas; — this is 

 perhaps not so noticeable in colder climates. The distribution of the anidrosis 

 can always be determined by pilocarpine injections. 



3. Glossy skill is frequently met with in the anaesthetic areas. 



4. Piginciitatioiis ami (iipigt)iciitatio)is likewise. 



5. Pemphigus eruptions are also met with. 



6. Loss of hair — particularh' of the supercilia and the cilia — is of 

 frequent occurrence in leprosy. On the head, however, there is rarely 

 any loss of hair. 



7. Ulcerations — Perforating ulcers, absolutely identical with those 

 observed in tabes dorsalis, are frequently seen in leprosy. They occur 

 chiefly in the feet. They usually lead to necrosis of the underlying bone 

 and do not heal till the necrotic bone has been extruded. 



8. Patiaritia of a peculiar kind are frequently seen in leprosy ; they 

 are as a rule accompanied by fever and may follow one after another. 

 They also have a tendency to lead to necrosis of the underlying bone. 



9. Dry necrosis of the distal parts of fingers and toes, leading, as do 

 also the two previous disturbances, to nuitilations. 



10. The most characteristic trophic disturbance is however the con- 

 centric atrophy of the small bones of the fingers and toes without any 

 lesion of the skin. This concentric atrophy consists in a gradual absorption 

 of the bone, so that this steadily grows smaller (shorter as well as thinner), 

 yet all the time keeping more or less its original shape. When this has 

 affected all the palanges of one finger; this latter still more or less retains 

 its shape, but becomes undersized, so much so, in fact, that at first sight 

 it looks like the finger of a small child, grafted on to the hand of an adult. 



11. In a few cases the bones become decalcified and flexible — 

 ■"Osteomalazie lépreuse" (LeloirI. Personally I have never seen this. 



12. Finallv, neuro-pathic joint lesions are also found. 

 Characteristic of all these disturbances (with the exception of 4 and 5) 



is their being localised in the distal parts of the extremities — just as we have 

 seen the more direct neurological manifestations of the leprosy neuritis to be. 

 Vid.-Selsk. Skrifter. I. M.-N. Kl. 1923. No. 16. 5 



