PART ii.j Mixed Cases of Tuberculated and AncEsthetic Phenomena. 467 



leprosy in the patient's family ; in the remaining 8 the existence of disease among 

 any relatives was denied. The affected relatives were in one case the father, in the 

 second the mother, and in the third the mother's brother. 



In 11 cases a history of the initial symptoms of the disease was obtained. In 

 7 the occurrence of patches of eruption is stated to have been the first symptom ; in 

 1 cracking of the skin of the heels followed by eruption ; in 2, cracking of the skin 

 of the feet; in 1, a similar affection of the skin over the ankle joints; and in 1, 

 generally diffused pain in the joints of the extremities. Here, as in the case of the 

 anaesthetic form of the disease, eruption seems to have been the most common initial 

 symptom. 



The blood was examined microscopically in 10 of the 12 cases. In 8 of these 

 the number of white corpuscles present in the specimens was excessive. In some 

 this excess was very strongly marked, and the normal white corpuscles were accom- 

 panied by an abundance of smaller bioplastic fragments. In 2 cases, the only 

 abnormal feature present was a soft and adhesive condition of the red corpuscles — 

 a condition which also occurred along with the excess of white corpuscles in one of 

 the other cases. 



4. — Analysis of the Cases in the Asylum affected equally by the Two FoTras of 



Disease — " Mixed " Leprosy. 



" Mixed " Leprosy. — This variety of the disease occurred in 15, or 18*6 per cent, 

 of the total cases. It was in one or two cases a matter of doubt whether cases included 

 under this head should not rather be referred to one or other of the previous categories, 

 but with regard to all the rest there could be no doubt as to the propriety of retaining 

 them in an intermediate class, as the tuberculated and ansesthetic phenomena were 

 so equally balanced, that it was impossible to say which predominated. 



From their very nature it necessarily follows that the variety in the symptoms 

 was very great. In some the only feature distinguishing them from purely anaesthetic 

 cases was more or less distinct thickening of the alae of the nose, or slight deposit 

 about the cheeks and eyebrows, and in one specially doubtful case the tubercles were 

 confined to the feet. The extent of anaesthesia also varied greatly. Special details 

 in regard to those points are unnecessary, as they would in great part consist of 

 repetitions of those previously given in connection with the tuberculated or anaesthetic 

 cases. In 1 case the tongue was anaesthetic, but the sense of taste was partially 

 retained. 



In 3 cases the skin was manifestly more or less affected apart from the changes 

 due to the presence of tubercular deposit. In one of these the skin of the face was 

 shrivelled and presented a peculiar dried-up appearance ; in another the skin about 

 the knees was shrivelled, in coarse folds, and marked by scars, and in the third there 

 was a white patch on the skin of one of the feet. 



