i66o 



LEPROSY 



The skin in the affected area becomes antesthetic; the hairs fall 

 out, and wrinkles and scales appear. After a time the areas cease 

 to spread, the raised margin disappears, and the disease becomes 

 quiescent. 



Meanwhile the infiltration into the nerve trunks has proceeded 

 to such an extent that a swelling can be easily felt in certain regions 

 — as, for example, in the ulnar behind the internal condyle, in the 

 great auricular over the sterno-mastoid, in the peroneal just below 

 the head of the fibula, and in other nerves in suitable places if 

 affected. With the destruction of the nerve fibres, the hyper- 

 aesthetic stage ceases and the anaesthetic stage of the disease begins. 



Fig, 731. — MACULO-ANiESTHETic Leprosy: Circinate Type. 



This is to be noticed along the ulnar side of the hand, forearm, and 

 arm, or on the inner side of the foot, first of all, and afterwards in 

 other places. It may be segmental in arrangement, restricted to the 

 distribution of a nerve, or in patches. At the same time the muscles 

 may be found to be paralyzed, notably the interossei of the hands, 

 but also those of the foot, if carefully looked for. The lower efferent 

 neurones being affected, the symptoms resemble those of muscular 

 atrophy of the Aran-Duchenne type, with the production of the 

 main-en-griffe and the extension of the paralysis to the muscles of 

 the forearm, and even at times, according to Jeanselme, to the 

 deltoid. As a result of the paralysis of the muscles of the fore- 

 arm the occurrence of dropped wrist is not uncommon. 



