268 



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 ap- 

 pearance is pro- 

 duced which has 

 been described as 

 "leonine." The 

 thickenings oc- 

 cur chiefly in the 

 cutis (Fig. 96), to 

 a less extent in 

 the subcutaneous 

 tissue. The epi- 

 thelium often be- 

 comes stretched 

 over them, and 

 an oozing sur- 

 face becomes de- 



FlG. 96. Section through leprous skin, showing the masses . 



of cellular granulation tissue in the cutis; the dark points are VeiOped,Or actual 



clumps of bacilli deeply stained. 



Paraffin section ; Ziehl-Neelsen stain. X 80. 



ulceration may 

 occur. The cor- 

 nea 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 situa- 

 tions the change is of the same nature, a sort of chronic in- 

 flammatory condition attended by abundant formation of gran- 

 ulation tissue, nodular or diffuse in its arrangement. In this 

 tissue a large proportion of the cells are of rounded or oval 

 shape, like hyaline leucocytes ; a number of these may be of 

 comparatively large size, and may show vacuolation of their pro- 

 toplasm and a vesicular type of nucleus. These are often known 

 as " lepra cells." Amongst the cellular elements there is a vary- 

 ing amount of stroma, which in the earlier lesions is scanty and 



