252 LEPROSY. 



effects of the bacilli are well marked, often extreme, whilst 

 the toxic phenomena are proportionately at a minimum. 



There are two chief forms of leprosy. The one, usually 

 called the tubercular form lepra tuberosa or tuberculosa 

 is characterised by the growth of granulation tissue in 

 a nodular form or as a diffuse infiltration in the skin, in 

 mucous membranes, etc., which often leads to great dis- 

 figurement. In the other form, the anaesthetic, maculo- 

 anaesthetic of Hansen and Looft the outstanding changes 

 are in the nerves, leading ultimately to destruction of nerve 

 fibres with consequent anaesthesia, paralysis of muscles, and 

 trophic disturbances. 



In the tubercular form the disease usually starts with the 

 appearance of erythematous patches attended by a small 

 amount of fever, and these are followed by the development 

 of small nodular thickenings in the skin, especially of the 

 face, of the backs of hands and feet, and of the extensor 

 aspects of arms and legs. These nodules enlarge and pro- 

 duce great distortion of the surface, so that, in the case of , 

 the face, an appearance is produced which has been described 

 as " leonine." The thickenings occur chiefly in the cutis, 

 to a less extent in the subcutaneous tissue. The epithelium 

 often becomes stretched over them, and an oozing surface 

 becomes developed, or actual ulceration may occur. The 

 cornea and other parts of the eye, the mucous membrane 

 of the mouth, larynx, and pharynx may be the seat of 

 similar nodular deposits. There may also be lesions in 

 internal organs, the spleen, liver, and testicles being most 

 commonly affected, the condition consisting of a slight 

 fibrosis with small nodular thickenings at places, which 

 chiefly follow the lines of the blood vessels. Less frequently, 

 lesions are present in other organs. In all situations the 

 change is of the same nature, a sort of chronic inflammatory 

 condition attended by abundant formation of granulation 

 tissue which may be of a nodular character, or more diffuse 

 in its arrangement. In this tissue a large proportion of the 

 cellular elements are of rounded or oval shape, like large 

 uninucleated leucocytes, and a number of these may be of 



