468 Leprosy in India. [part ii. 



In 7 cases active ulceration was present, in 6 of them confined to the extremities, 

 and in 1 affecting the nose. In 3 the toes showed degenerative changes in more 

 or less marked degree, and in 5 there had been more or less complete loss of digits. 



In 7 cases the voice was affected, being husky to a greater or less degree, and 

 in 2 the nose was sunken ; in neither of these was there any discharge associated with 

 the condition, nor was there any history of syphilis. 



The cases consisted of 8 males and 7 females, or 17*3 per cent, and 20*5 per 

 cent, respectively on the total male and female inmates of the Asylum. 



The ages of the patients varied from 16 to 54, with an average of 33-8 for the total. 

 The date of attack varied from 3 years to 40 years of age ; 5 cases were attacked pre- 

 vious to 10 years of age ; 3 between 10 and 20 ; 2 between 20 and 30 ; 4 between 

 30 and 40 ; 1 at 40. The average age of attack was 20*2 years. The duration 

 of the disease ranged from 5 to 24 years ; in 4 cases it was beneath 10 years ; in 

 8, between 10 and 20 years ; in 3, between 20 and 30. The average duration was 

 13*66 years. 



In 6 cases, or 40 per cent., there was a history of disease among the patients' 

 relatives. In 1 both parents and four brothers were lepers, in 2 the father was a 

 leper, in 2 the mother, and in 1 a son. 



In 14 of the cases a history of the initial symptoms was obtained. In 9 the 

 disease was stated to have begun with eruption over more or less of the surface of 

 the body ; in 1 by the appearance of small tubercles, in 1 by the occurrence of a 

 blister over one of the hip joints, in 1 by cracking of the skin of the soles of the 

 feet, in 1 by a similar affection accompanied by thickening of the face, and in 1 by 

 thickening of the ears. 



The blood was examined in 13 cases. In 7 it appeared to be quite normal, in 

 4, the white corpuscles were present in excess; in 1, excess of white corpuscles was 

 associated with an abundance of bioplastic fragments and a soft glutinous condition of 

 the red corpuscles, and in 1 a- similar condition of the red corpuscles was the only 

 peculiarity. In 1 case bleeding occurred on the slightest irritation over the anaesthetic 

 areas, and in another blood could only be obtained with difficulty. 



5. — Analysis of cases in the Asylum in which the eruption was the most marked 



feature — " Eruptive " Leprosy. 



Although it is questionable whether this should be separated as a variety from one 

 or other of the previous categories, seeing that the eruption seems rather to constitute 

 a symptom common to the previous classes ; there are, at the same time, certain cases 

 in which this symptom is of such marked and persistent character as to justify 

 their separation. Four cases of this kind were met with among the inmates of the 

 Almora Asylum. Of these three were males and one a female. 



In 3 of them the symptoms associated with the eruption were of a markedly 



