66 



G. H. MONRAD-KROHN. 



-N. Kl. 



This conformit}' as to localisation is one of the chief arguments in 

 favour of their neuro-pathic origin. It has to be added that also the nasal 

 bones are not infrequently the seat of trophic disturbances. 



Muir mentions a case where the whole of the astragalus had dis- 

 appeared. Otherwise it is chiefly the small bones that are affected by the 

 trophic disturbances. 



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Fig. 36. (Case No. 4. K. P.) Dorsal aspect of left hand. 

 Whilst the proximal parts of the other fingers as seen in 

 the sketch are of normal size, the little finger has been 

 enormously reduced in size as a result of concentric 

 atrophy. It is surprising how well the skin adapts itself 

 to the reduced size of the palanges. 



Fig. 37- (Case No. 41. B. K.> 

 Volar aspect of left hand. Com- 

 plete atrophy of thenar and 

 hypothenar. 2nd — 5th finger 

 mutilated — 2nd finger still 

 carries a rudiment of a nail. 



The more profound of these trophic disturbances lead to extensive 

 deformities and multilations of hands and feet and — in connection with 

 the muscular atrophy and paralysis — give rise to a ver}^ characteristic 

 appearance of the patients' hands and feet. (Cpr. Figs. 36 — 39.) 



Besides the localisation of the most distal parts of the limbs already 

 mentioned, the most characteristic feature of the leprous mutilations is perhaps 

 the fact, already pointed out by Poncet, that the nails in leprosy have a great 

 tendency to remain. Thus are frequently seen the most deformed little 

 rudiments of fingers adorned with nails or remnants of such. 



