LEPROSY. 197 



agencies upon the feebly vital pathological tissue, which 

 is unable to recover itself when injured. 



In that form known as anesthetic leprosy, nodules form 

 upon the peripheral nerves, and by connective-tissue 

 formation, as well as the entrance of the bacilli into the 

 nerve-sheaths, cause irritation, then degeneration, of the 

 nerves. The anesthesia which follows these peripheral 

 nervous lesions is one of the conditions predisposing to 

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

 without detection and to progress without observation. 

 The ulcerations and occasional loss of phalanges that 

 follow these lesions occur, probably, in the same manner 

 as in syringomyelia. 



The disease advances, having first manifested itself 

 upon the face, extensor surfaces, elbows, and knees, to the 

 lymphatics and the internal viscera. Death ultimately 

 occurs from exhaustion, if not from the frequent inter- 

 current affections to which the conditions predispose. 



