MACULO-AN ESTHETIC LEPROSY 



Special leucocytic index. Some authors state that they have found 

 the specific bacillus in leucocytes, or, more rarely, free in the peri- 

 pheral blood. Wassermann's reaction is, in our experience, at times 

 present even in cases where there is no history of syphilis or yaws. 



Urine. — There are not many observations upon the urine. The 

 most marked feature is a great increase in the ethereal sulphates. 

 Brinton, of Rio de Janeiro, has isolated two ptomaines from the 

 urine, one allied to choline and the other to muscarine. 



The nerves may become attacked, and the signs and symptoms 

 of nerve leprosy be added to those of the tubercular, forming a 

 variety of mixed leprosy. 



The ulcerations generally become marked towards the end of 

 the disease. If treated, they cicatrize and produce deformities; 

 if left to themselves, they suppurate and produce amyloidosis, or, 

 becoming phagedaenic, cause gangrene of the fingers or toes, and 

 septic poisoning. 



Complications, in the form of phthisis and amyloidosis, appear, 

 causing fever, cough, and expectoration, diarrhoea, and enlargement 

 of liver and spleen. 



Unfortunately, in the midst of disease of almost every organ 

 of the bod3^ the mind is quite clear; but the patients are most 

 irritable, and it is not surprising that, under these circumstances, 

 the patients of a leper asylum require considerable tact in manage- 

 ment, and are often peevish and discontented, and that small 

 rebellions occur. 



MACULO-AN^STHETIC LEPROSY, 



In this form of leprosy the infiltration takes place principally 

 into the nerves, with the result that first the fibres are irritated, 

 and later they become destroyed. The first stage is therefore one 

 of irritation of the nerves, with such symptoms as shooting-pains 

 down certain nerves, especially the ulnar and the peroneal, accom- 

 panied with sensory disturbances, such as burning, numbness, 

 formication, along with vasomotor disturbance — e.g., flushings of 

 the face, glossy skin — and motor disturbance, such as twitching 

 of the muscles, particularly of the face. 



Sooner or later a macular eruption appears, which is looked upon 

 by some as due to a lepromatous infiltration of the skin, and by 

 others as nervous in origin. This macular eruption may appear 

 as flat red spots of various shapes and sizes, neither hypersesthetic 

 nor anaesthetic at first, which appear without fever or any general 

 disturbance of the health. Other maculae may appear which, 

 instead of being red, are simply pigmented, while stifl others may 

 be seen in which the pigmentation is less than usual. In any case 

 the spots grow larger, the centres becoming pale, while the peri- 

 pheries, which are usually raised, and occasionally marked with 

 papules or vesicles, or covered with dry whitish scales, may coalesce 

 with other spots, forming large areas. 



