466 Leprosy in India. [part ii, 



depressing them and almost closing the eyes, the general thickening of the cheeks, 

 and the tri-lobed condition of the nose are all clearly visible. 



Where tubercular deposits occurred in the extremities it was often difficult to 

 determine to what extent they were due to deposit in the course of the cutaneous 

 nerves, and how far to material actually occupying the tissue of the skin itself. Many 

 of them were, however, so superficial, that if in any way specially connected with the 

 nerves, it could only have been with their terminal filaments. 



Ancesthesia. — In only one case did this appear to be entirely absent. This was 

 an acute case of short duration ; the patient was a boy of 10, and the disease had 

 only lasted for one year. In the other cases the areas occupied by deposit were more 

 or less completely anaesthetic, but general anaesthesia of entire regions was much less 

 common, complete, or extensive than in the form of the disease first described. When 

 present, it showed the same preference for the extremities and for the extensor rather 

 than the flexor surfaces of the affected limbs, as was previously noted in reference to 

 anaesthetic leprosy (p. 460). 



In one case only was pain complained of. It extended across the dorsum of the 

 right foot from the fourth toe, which was distorted and swollen, to the inner side of 

 the ankle joint. 



Except over the sites of deposit, the skin of the patients as a rule presented no 

 abnormal appearances. In 2 cases a scaly eruption was present, which in 1 covered 

 the extremities and the lower portion of the trunk, and in the other was situated over 

 the ankle joints. In 5 cases there were open ulcers on the feet or hands, in 1 

 there was also a large open ulcerating surface on the right cheek (Plate XXXI, Fig. 2), 

 and in another the tongue was ulcerated. In 5 cases the extremities were quite 

 unaffected by ulceration, distortion, or absorptive changes of any kind ; in the remaining 

 7 there was more or less distortion or other evidence of a leprous affection. 



The voice was affected in 10 out of the 12 cases. Of the remaining 2, one 

 patient was dumb, the other was the boy previously mentioned as presenting no 

 anaesthetic symptoms. The affection of the voice was probably due to tubercular 

 deposit about the larynx, and was no doubt considerably influenced by the condition 

 of the nose, which was sunken in 5 cases, and in others appeared to be so, due to 

 the thickening and prominence of surrounding parts. 



The ages of the patients ranged from 10 to 39 years, with an average of 27 years. 

 The earliest date of attack was 9 years, the latest 30. Taking the 11 cases in 

 regard to which information as to age could be obtained, 1 was attacked under 10 

 years of age, 6 between 10 and 20, 3 between 20 and 30, and 1 at 30. The 

 average date of attack for the 11 cases is 18-90 years. 



The duration of the disease varied from 1 to 14 years with an average of 8-27 

 for all cases. Of the cases 8 had lasted for a period of under 10 years, and 3 for 

 periods between 10 and 20 years. 



In 3, or 25 per cent, of the cases, there was a history of the occurrence of 



