i86 DISEASES DUE TO BACTERIA 



About the mouth. 



Tongue, mouth and pharynx may be affected, mastication and 

 deglutition difficult; when in larynx the voice becomes raucous, 

 respiration impeded. Lips become paralysed, saliva dribbles, gums 

 retract, teeth fall out, taste is lost. 



About the skin. 

 A goat-like odour. Tubercles on hands, arms and legs which may 

 ulcerate. 



Submaxillary, cervical and femoral glands may be enlarged and 

 may suppurate. 



Testes fibrous, menstruation irregular and may cease. 



Fingers and toes atrophy, ulcerate, drop off, then phalanges and 

 metacarpals likewise. 



Blood. 



Nil diagnostic. No marked or consistent changes. 



Nerves may be attacked and add their corresponding signs and 

 symptoms. 



Ulcerations may cicatrize and produce deformities or suppurate and 

 produce amyloidosis or become phaged^enic causing septic poisoning, 

 gangrene of fingers or toes. Nephritis is common. 



(2) ANAESTHETIC VARIETY. 



Infiltration is chiefly in the nerves; fibres irritated at first, then 

 destroyed. Shooting pains of ulnar and peroneal. There are sensory 

 disturbances as burning, numbness, formication; vasomotor disturb- 

 ances as flushings, glossy skin; and motor disturbances as facial 

 twitchings of muscles. 



A macular eruption, flat red spots appear without any general 

 disturbances, some being pigmented. Spots increase in size, centres 

 become pale, the peripheries usually are raised, marked with papules 

 t)r vesicles, or dry whitish scales. Such areas may coalesce forming 

 patches half an inch to six inches in diameter. 



Within these, the skin is anaesthetic, hairs fall out, does not sweat. 



Wrinkles and scales appear. 



Hypersesthetic outer border may look like a big ringworm. 



The disease may become quiescent and fade at any time. 



Nerves. — Ulnar nerve thickened, felt behind internal condyle, great 

 auricular felt over sternomastoid. Peroneal below head and fibula, &c. 



With destruction of nerve, hyperaesthesia ends and anaesthesia 

 begins. 



Noticed first usually along ulnar side of hand and f<:)rearm. 



It may be patchy or in distribution of nerve. 



