( 82 ) 



Any thickening of the skin, circumscribed, and of a coppery red 

 tinge, should be suspected. 



Loss of feeling, even to sharp bodies, such as a pin, if it is found 

 in a hardened patch of skin is very suspicious. Thickening of the 

 nerves, for example an enlargement and hardness of the nerve at the 

 inside of the elbow— "the funny-bone"— should lead one to examine for 

 anaesthetic patches elsewhere. 



Chronic ulcers of the feet particularly of the sole of the foot, are 

 frequently leprous. 



The physiognomy of a leper is quite distinctive to the trained 

 eye, and when the seared, leonine expression is present, cannot be 

 mistaken. 



Irregular and usually slight attacks of fever occur early in leprosy, 

 the later signs, such as the loss of fingers and toes and repulsive 

 ulcerations of the body, are, mercifully, seldom seen save in the 

 asylums provided for these unfortunate beings. 



Abscess of the Liver. 



The fever emaciation and general illness preceding the full 

 development of this disease are so variable and progressive, that its 

 diagnosis is hardly a subject for this pamphlet. 



Early operation is the secret of success, and all that I need mention 

 about it will be a quotation from Sir Patrick Manson's lectures * 

 the London School of Tropical Medicine: "Whenever you find J 

 progressive deterioration of health and vigour occurring, accompanied 

 by some fever and sweats, al ways suspe ct liver abscess." 



Sprue. 



diaJ, ^ ^ a J pr6cis of s P rue ^ a difficult task. Where tropical 

 oWn 7 Spme be S lns is not easy of definition, but if I 



deterinr a Hn d * scn P tlve e Pigram, I would say, "sprue is a chronic 

 deterioration of mucous membranes of unknow n causation." 

 a cnI^ ym ?° mS c m ^ y be re Presented by various combinations of * 

 a conglomeration of the following •— 



pains^alnT' t0ngUe > "deration of the mouth, abdom^ 



pains, pain on swallowing, pa l e stools eassv stools loss of weight 

 i« ka f ° f I insider sprue to be «mg 

 cTs^ the mi 165 ? th i S u C ° Untr > ' but the difficulty of accurate diagnosis- 

 causes the majority of the cases to be returned as diarrhoea. 



Z3EZ£tt»steZ 5ore mouth ' that roany 



