268 



LEPROSY 



changes are in the nerves, with consequent anaesthesia, paralysis 

 of muscles, and trophic disturbances. 



In the tubercular form the disease usually starts with the 

 appearance of erythematous patches attended by a small amount 

 of fever, and these are followed by the development of small 

 nodular thickenings in the skin, especially of the face, of the 

 backs of hands and feet, and of the extensor aspects of arms and 





FIG. 91. Sections through leprous skin, showing the masses of cellular 

 granulation tissue in the cutis ; the dark points are clumps of bacilli deeply 

 stained. 



Paraffin section ; Ziehl-Neelsen stain, x 80. 



legs. These nodules enlarge and produce great distortion of the 

 surface, so that, in the case of the face, an appearance is produced 

 which has been described as "leonine." The thickenings occur 

 chiefly in the cutis (Fig. 91), to a less extent in the subcutaneous 

 tissue. The epithelium often becomes stretched over them, 

 and an oozing surface becomes developed, or actual ulceration 

 may occur. The cornea and other parts of the eye, the mucous 

 membrane of the mouth, larynx, and pharynx, may be the seat 

 of similar nodular growths. Internal organs, especially the 

 spleen, liver, and testicles, may become secondarily affected. In 



