522 DISEASES OF THE SKIN. 



temperature. But generally there are remains of other morbid af- 

 fections, which have existed with or before the skin trouble, and 

 must have impaired the circulation, as pulmonary atelectasis, pneu- 

 monia, heart-disease, intestinal catarrh, and ulcers. 



TREATMENT is to be directed against these causal diseases, to 

 securing good nourishment by a wet nurse, Nestle's food, nutrient 

 enemata, wine, ether, musk, etc., and improving the circulation by 

 wrapping the child in flannel, hot baths, etc. 



LEPROSY ELEPHANTIASIS GR^ECORUM. 



Leprosy, which was formerly so dreaded, and which is still en- 

 demic in some countries, and was so even in Europe previous to the 

 fifteenth century, still occurs sporadically. Although our knowl- 

 edge of this disease has of late been greatly enriched, its origin is 

 still uncertain ; but it has been ascertained that a minority of cases 

 were hereditary, and that the disease is not contagious. Although 

 the symptoms of leprosy are not always the same, still the cases 

 show that they are of the same general character. Among the 

 forms that have been described are lepra maculosa, I. tuberculosa, 

 and I. ancesthetica. The disease rarely begins before the seventh 

 to the tenth year ; it is more common in youth and middle age. 

 The local symptoms are usually preceded for a long time by 

 general symptoms, such as heaviness, chills, loss of appetite, vague 

 pains, evening fever, etc. In the maculous variety, spots come on 

 the skin ; these may disappear on pressure, and they may be dark 

 or white ; the disease may run its course with these appearances, or 

 combine with the other two forms. In the tuberculous form, sen- 

 sitive nodules as large as a nut form on the maculas or on healthy 

 skin. These nodules may be scattered or congregated ; they come 

 especially about the face and limbs. After it has lasted a long 

 time, the mucous membrane of the mouth, larynx, nose, and eye 

 may be aifected. Leprous nodules may last for years and then pass 

 away, leaving a dark pigmentation or spot of white atrophy in the 

 skin ; more rarely they soften and form abscesses, or ulcerate, even 

 going deep enough to expose the bones and open the joints, espe- 

 cially of the hand and foot. 



Although cutaneous anaesthesia accompanies spotted and nodular 

 leprosy, in the form called anaesthetic loss of sensation exists in the 

 skin without spots or nodules. Later the anaesthetic spots become 

 flabby, yellow, and atrophied ; the muscles of the face and hands 

 participate in the atrophy ; the skin breaks through, leaving a tor- 

 pid, lifeless opening, which slowly enlarges, and finally exposes or 

 even detaches phalanges or portions of limbs. The anaesthesia of 



