PART II.] Nervous Phenomena, other than Ancesthesia, to be noted. 461 



Having thus discussed the phenomena of the diminution, or disappearance, of the 

 sensibility of the external surface of the body, there yet remain one or two ansesthetic 

 and other nervous symptoms to be noted in reference to the cases. The condition of 

 the tongue and fauces in relation to common and special sensation was inquired into 

 in numerous cases. As a rule, both touch and taste, according to the patient's 

 account, remained intact, and only in very advanced cases was there any evidence of 

 loss of either. In one case the tongue was anaesthetic to touch, but the sense of 

 taste was retained, whilst in another the reverse condition was present. 



In 4 cases only did the patients complain of any pain, in spite of the great 

 prevalence of open ulcerating surfaces among them. In one the sites of pain were 

 referred to the inner side of the right and outer side of the left calves, extending 

 to the knee-joints, and a certain amount of prominence of the cutaneous nerves 

 over corresponding areas could be detected. In another case pain was complained 

 of along the inner sides of both calves, in a third the big toes were painful, and in 

 another the pain was connected with ulcerations of the soles of the feet. In several 

 other cases, although no general complaint of pain was made, the exposed surfaces 

 of the phalanges of the fingers and toes were tender and painful when touched. 

 That pain cannot be a common or troublesome accompaniment of leprosy among 

 the inmates of the Almora Asylum is sufficiently evident from the happy and cheerful 

 demeanour manifested by the majority of them. 



Dimness of vision was complained of in one case. The eyes showed no external 

 signs of disease, but as an ophthalmoscopic examination could not be made it remains 

 uncertain whether or not this were due to the existence of deposit on the retina. In 

 one very advanced case the patient was blind,' but this was due to opacity of the 

 cornea. 



In 1 or 2 cases there were obvious thickenings along the course of the 

 cutaneous nerves supplying anaesthetic areas. The skin in many instances showed 

 no special indications of disease apart from ulcerations or the cicatricial traces of 

 former ones. In 17 cases, however, there were more or less decided alterations 

 in the skin over the surface of one or other portion of the body. The commoner 

 forms of these were general shrivelling and puckering of the surface, which at the 

 same time presented a peculiarly dry aspect ; the occurrence of coarse folds of 

 skin about the elbows and knees ; the presence of fissures in the hands, and more 

 especially in the soles of the feet, and the occurrence of discoloured patches of various 

 extent. The cause of the shrivelled and folded condition of the skin is no doubt 

 to be ascribed in great part to partial atrophy and diminution in bulk of the 

 subjacent muscles, and may in part also be due to affection of its intrinsic muscular 

 elements. The cracking of the skin is a very common symptom, and is, as we 

 shall see, frequently the first to warn the patient of the onset of disease. The patches 

 of discoloration were sometimes of a whitish hue, and were then usually situated 

 about the elbows, knees, hands, and feet. In 3 cases there were large irregular 



