462 . Leprosy in India. [part ii. 



patches of light discoloration, probably the remains of leprous eruption, over the 

 back and shoulders ; and in one the same regions were occupied by similar patches 

 of pinkish colour. In 1 case the hands and feet were sv/oUen and scaly, and in 

 another a scaly eruption was present over the ankles. In 2 cases there was a very 

 peculiar bluish cyanotic hue of the palms of the hands. 



In 1 case there was marked enlargement of the inguinal glands. In 35 

 cases open ulcers were present, sometimes on both the hands and feet, very rarely 

 on the hands alone, frequently on the feet alone. They were in many ascribed to 

 burns or other injuries incurred, due to the anaesthetic condition of the affected 

 surfaces, and this probably is the explanation of their more frequent occurrence 

 on the feet. In most cases they were said to heal readily and easily, which, with 

 the phenomena frequently attending their causation, points to the non-specific or 

 essentially leprous nature of many of such ulcers, not being dependent on the 

 breaking down of any deposit, but merely due to accidents or mal-nutrition induced 

 by the effects of such deposit elsewhere. This is a point on which Virchow lays 

 particular stress. * The inference is also borne out by the microscopic examination 

 of the discharges from such ulcerating surfaces, for, in so far as we could ascertain 

 from those cases in which we examined such materials, they contain no special cells 

 or other morphological elements not common to an}'^ non-specific ulcerating surfaces. 



In only 3 cases was there an entire freedom from ulceration or absorption 

 of the digits of both hands and feet. In all the rest one or other condition was 

 present in greater or less degree, sometimes affecting the hands or even one hand 

 only, whilst the feet escaped, in others having a reversed distribution, but in the 

 vast majority affecting both upper and lower extremities simultaneously. The degree 

 to which the affection of the digits was present varied greatly, ranging from mere 

 cracks and superficial ulceration of the tips of one or two fingers or toes up to the 

 total absence of the whole of all of them, and in some cases even to partial dis- 

 appearance of one or more metacarpal bones {vide Plate XXX). In most cases the 

 mutilation appeared to have been caused by progressive ulceration or by necroses en 

 masse of one or more joints at a time, but in some the digits appeared rather to 

 have been removed by a process of interstitial absorption, as the nails in a more or 

 less entire condition, adhered to the remnants of hands or feet which still persisted. 



In many cases the remaining digits were strongly contracted, the contraction 

 in some instances causing most curious distortions, as in those where there was 

 permanent flexion of the proximal phalanges with extension of the distal one of 

 one or more fingers — a condition present in several instances. 



In advanced cases of long duration there was frequently, in addition to distortion 

 due to contraction, extreme muscular atrophy, the entire muscles of the ball of the 

 thumb and palms of the hands appearing to have disappeared, leaving the bony 

 framework covered by the skin alone. This was especially remarkable in one or 



* Die Krankhaften Geschiotilgte. Zweiter Band ; Seite 529. 



