Varieties 



773 



In such preparations the bacilli are present in enormous 

 numbers, thus forming a marked contrast to tuberculous 

 skin diseases, in which, very few can be found. 



In anesthetic leprosy nodules form upon the peripheral 

 nerves, and by connective-tissue formation, as well as by 

 the entrance of the bacilli into the nerve-sheaths, cause 

 irritation, followed by degeneration of the nerves. The 



Fig. 252. A case of lepra nodosa treated in the Medico- Chirurgical 

 Hospital of Philadelphia. 



anesthesia following the peripheral nervous lesions pre- 

 disposes to the formation of ulcers, etc., by allowing injuries 

 to occur without detection and to progress without observa- 

 tion. The ulcerations of the hands and feet, with frequent 

 loss of fingers and toes, follow these lesions, probably in the 

 same manner as in syringomyelia. 



The disease usually first manifests itself upon the face, 

 extensor surfaces, elbows, and knees, and for a long time 

 confines itself to the skin. Ultimately it sometimes invades 



