PART 11?^ Distribution of the Deposit in the Tuberculated Form of Leprosy. 465 



by patches of eruption accompanied by cracking of the heels ; in 1 by eruption and 

 the appearance of bullae on the feet ; in 5 by cracking of the soles of the feet ; in 

 1 by pain and cracking of the skin over one ankle ; in 3 by the appearance of bullae 

 on various parts of the body ; in 2 by ulceration of the extremities ; in 2 by the 

 appearance of abscesses ; in 1 by whitlow and necrosis of one of the fingers ; in 1 by 

 swelling and pain of the toes. If any conclusion is to be arrived at from these state- 

 ments, it is that the commonest symptom attracting attention to the commencement 

 of the disease is an eruption of some form, such having occurred, it is affirmed, in 31 

 of the 49 cases. 



3. — Analysis of the cases in the Asylum affected with the Tuberculated 



form, of Leprosy. 



There were 12 cases, or 15*0 per cent, of the total cases, in which nodular 

 appearances were by far the most prominent features in the disease. Of these 10 

 were males and only 2 were females, or 21-7 per cent, and 5*8 per cent, respectively 

 on the total lepers in the Asylum. 



Distribution of the nodules. — In all these cases the face and ears were the seats 

 of tubercular deposit. In all save two the deposit there was extensive, and exceeded 

 that in other sites. In 1 only was tubercular deposit in the extremities the most 

 conspicuous feature, and in another it was generally diffused over the body. In 2 

 cases the tongue was greatly invaded, and in many others it was more or less affected. 

 In 5 cases the evidences of tubercular deposit were limited to the face and ears ; 

 in the rest the extremities and other parts of the body participated to a greater or 

 less extent. 



The distribution of the deposit on the face, ears, etc., varied greatly in different 

 instances, and the manner in which it was deposited also exhibited considerable variety. 

 In some cases it was diffused, causing general thickening over wide areas ; in others it 

 occurred as isolated, sharply-defined, prominent nodules. The sites of chief deposit 

 were those well known as those specially selected in the disease — the malar prominences, 

 eyebrows, nose and ears. In some cases there were prominent tubercles on the upper 

 eyelids, which added considerably to the deformity due to the general thickening of 

 the tissues and the coarse deep furrows on the forehead between the various areas of 

 deposit. The deposit, when affecting the nose, generally appeared to take origin around 

 three centres, affecting the tip and alee respectively. This caused the formation of 

 irregular lobes, and, when the condition was advanced, ended in causing the nose to 

 present a distinct tri-lobed extremity. The lobes of the ears were very greatly affected, 

 becoming thickened, nodular and pendulous, whilst smaller masses of deposit caused 

 irregular roughening and thickening along the rims. The appearances present in 

 advanced cases are very well shown in Plate XXXI, Fig. 1, where the pendulous nodulated 

 ears, the coarse folds on the forehead, the prominent tubercles on the upper eyelids, 



32 



