460 ^ Leprosy in India. [part it, 



sensation. In 1 the hands alone were affected, in 1 the extensor surfaces alone 

 from a little above the elbow. In 1 the extensor surfaces throughout and the 

 entire hands, save the tips of the fore and ring fingers and the ball of the right 

 thumb, were angesthetic ; in another the anaesthesia was complete, save over the upper 

 third of the inner surfaces of the arms. In no cases were the arms affected without 

 the forearms ; in 1 there was no anaesthesia present ; in 1 only it was confined to 

 the hands, and in 5 there was evidence of a greater liability to disease of the 

 extensor as compared with the flexor surfaces. 



6. The, lower extremities. — In 18 of the 49 cases the entire extremities were 

 affected; in 15 complete anaesthesia was present from the knees downwards; in 1 

 the condition was similar, save that the areas corresponding with the lower half 

 of the popliteal spaces were sensitive. In 4 cases complete anaesthesia was 

 present from the mid-thigh ; in 1 from mid-thigh anteriorly, and over the entire 

 posterior surface, save the popliteal areas. In 3 cases there was complete anaesthesia 

 from the knees with diminished sensibility of the thighs; in 2 the anaesthesia 

 was universal, save over the upper third of the inner surface of the thighs ; in 

 one it was complete over the entire surface externally and posteriorly, and from the 

 ankles only on the inner surface. In 1 case the popliteal area of the right side 

 alone escaped. In 1 anaisthesia was present from the upper third of the legs, in 

 1 from the ankles, and in 1 confined to the feet. 



7. The trunk. — In 5 cases the entire surface of the trunk was completely 

 anaesthetic, and in another the patient affirmed this to be the case, although at the 

 same time distinct twitching of the surface followed irritation. In 4 cases sensibility, 

 although much diminished, was not absent, and in 1 of these the posterior was 

 less affected than the anterior surface. In 1 there was partial anaesthesia passing 

 into total absence of sensation over the gluteal regions ; in 1 there was complete 

 anaesthesia anteriorly, and in another complete anaesthesia posteriorly. In 1 anaesthesia 

 was confined to the shoulders ; in 4 to the gluteal regions ; in 1 to the left gluteal 

 region ; in 1 to the loins ; and in another to a patch behind the spleen. 



The general results of this analysis of cases illustrate the well-known tendency 

 to peripheral over central localisation of the affection, and also clearly demonstrate 

 the distribution of anaesthesia according to nervous areas. One of the most interesting 

 points noticed is that in reference to the ears, apparently indicating that the internal 

 surfaces and the tragi are less liable to suffer than the rest of the ears, implying a 

 corresponding comparative exemption of the auriculo-temporal nerve as compared with 

 the other nerves supplying the external ear. The distribution according to nervous 

 areas is also illustrated by other phenomena — by the exemption of the upper lip and 

 chin, by the sharp limitation of anaesthesia to the line of the lower jaw and to the 

 gluteal regions on the trunk, by the greater liability of the extensor as compared 

 with the flexor surfaces of the upper, and of the outer with the inner surfaces 

 of the lower extremities. 



