298 



LEPROSY 



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 produce great distortion of the 

 surface, so that, in the case of the face, an appearance is produced 



FIG. 86. Sections through leprous skin, showing the masses of 

 cellular granulation tissue in the cutis ; the dark points are cells 

 containing bacilli deeply stained. 



Paraffin section ; Ziehl-Neelsen stain, x 80. 



which has been described as " leonine." The thickenings occur 

 chiefly in the cutis (Fig. 86), 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 growths. Internal organs, especially the 

 spleen, liver, and testicles, may become secondarily affected. In 

 all situations the change is of the same nature, consisting in an 



