LEPROSY 



fever of an intermittent or irregular character, with a marked 

 feeUng of general illness, associated with headache and pains in 

 different parts of the body, peculiar sensations of cold, formication 

 or numbness in various places, and, above all, of abnormal local or 

 general perspirations. These attacks of leprotic fever, without any 

 definite clinical signs of leprosy, may occur at intervals for years. 

 This fever is probably due to the dissemination of the bacilli through 

 the body, and may represent a septicaemic process due to the 

 Bacillus lepm. 



After the general dissemination through the body, the bacilli 

 appear to settle mainly in the skin or in the nerves, though, of 

 course, there are many cases in which they settle in both. It is 

 therefore convenient to distinguish the two varieties of the disease, 

 first differentiated by Danielssen and Boeck — viz., 'lepra tuber- 

 culosa,' or ' nodular leprosy,' and ' lepra niaculo-an^sthetica,' or 

 ' smooth leprosy ' — remembering that the division is artificial, and 

 that numerous cases exist which show both forms. 



TUBERCULAR LEPROSY. 



After repeated attacks of fever the patient has a more severe one, 

 during which an erythematous, diffuse, or macular eruption appears 

 on the face and limbs. The fever subsides, and the maculae may 

 disappear or thicken and become tubercles, which are dermal lesions 

 projecting from the skin or mucosae, in addition to which there are 

 subdermal infiltrations, which can be more easily felt than seen. 

 If they disappear, it is only for the time, as new maculae will appear 

 with a new attack, and sooner or later the thickening will take 

 place, and the nodules or tubercles, typical of the disease, will 

 appear. Each outbreak of nodules is in some cases preceded by 

 an attack of fever, with or without an erysipelatous-like eruption 

 in the area to be affected, associated with enlargement of the 

 lymphatic glands. In our experience, however, the fever may be 

 absent in many cases. 



The nodules may form all over the skin, but are most common 

 on the face and limbs. In the former situation they appear on the 

 forehead, cheeks, alae of the nose, lobules of the ears, lips, and chin, 

 and as they increase in size, totally alter the appearance of the 

 patient, defacing the natural facial hnes, and forming new furrows 

 between adjacent nodules; while at the same time, in manj^ cases, the 

 hairof the beard, moustache, and eyebrows drops out. These changes 

 result in the countenance becoming like that of a satyr or, when 

 the furrows are more marked, like that of a lion; hence the terms 

 ' satyriasis ' and ' leontiasis,' which the ancients applied to the disease. 



Eye lesions are more commonly met with in this form of the 

 disease, for Borthen, as the result of his investigations, concludes 

 that only 8 -08 per cent, of women and i -67 per cent, of men suffer- 

 ing from tubercular leprosy escape without some form of disease of 

 the eyes or their adnexa. Women are, however, less affected than 



