CHAPTER XL 



LEPKOSY. 



Leprosy is a disease of great interest, alike in its clinical and 

 pathological aspects ; whilst from the bacteriological point of 

 view, also, it presents some striking peculiarities. The disease 

 has a very wide geographical distribution. It occurs in certain 

 parts of Europe — Norway, Eussia, Greece, etc., but is commonest 

 in Asia, occurring in Syria, Persia, etc. It is prevalent in Africa, 

 being especially found along the coast, in the Pacific Islands, in 

 the warmer parts of North and South America, and also to a 

 small extent in the northern part of North America. In all 

 these various regions the disease presents the same general 

 features, and the study of its pathological and bacteriological 

 characters, wherever such has been carried on, has yielded 

 similar results. 



Pathological Changes. — Leprosy is essentially a chronic 

 disease, in which there is a great amount of tissue change, with 

 comparatively little necessary impairment of the general health. 

 In other words, the local effects of the bacilli are well marked, 

 often extreme, whilst the toxic phenomena are proportionately 

 at a minimum. 



There are two chief forms of leprosy. The one, usually called 

 the tubercular form, — lepra tuber osa or tuberculosa, — is character- 

 ised by the growth of granulation tissue in a nodular form or 

 as a diffuse infiltration in the skin, in mucous membranes, etc., 

 great disfigurement often resulting. In the other form, the 

 anaesthetic, — maculo-ansesthetic of Hansen and Looft, — the out- 

 standing changes are in the nerves, wi|h consequent anaesthesia, 

 paralysis of muscles, and trophic disturbance*. 



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 



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