i662 



LEPROSY 



or feet, and when broken may form ulcers. Injuries to anaesthetic 

 areas may also result in ulcers, which may be of the perforating 

 type. Fissures may form in the digits, hands, or feet, and, more 

 rarely, dry gangrene may cause loss of the fingers or toes, or greater 

 portions of the limbs, and, still more rarely, the bones of the 

 fingers will soften and become osteomalacic. Trophic lesions of 

 the elbow or knee, like Charcot's joints, have been recorded.^ 



Jeanselme, Bourret, and one of us have studied the cerebro- 

 spinal fluid, and have found in a few cases a lymphocytosis, but 

 more usually no cells or bacilli. 



The eye is far less commonlyaffected than in the tubercular variety, 

 Borthen's figures showing that in anaesthetic leprosy no less than 

 36-83 per cent, of the female cases and 26-80 per cent, of the male 

 cases escape without eye complications. True leprotic lesions are 



much rarer, the eye being damaged by secondary infections brought 

 about by the absence of the lachrymal secretion and the lag op h- 

 thalmos. The forehead and supraciliary regions are often red- 

 dened and oedematous, but complete madarosis is rare; while 

 paralysis of the frontalis, corrugator supercilii, and orbicularis 

 palpebrarum cause lagophthalmos and ectropion; and as there is 

 a diminution in the secretion of tears, xerophthalmia with posterior 

 or total symblepharon, while desiccation and destruction of the 

 cornea may result. 



Secondary infections may lead to keratitis, onyx, hypopyon, 

 iritis, irido-cyclitis, and destruction of the eye. 



Sterility is not so frequent in nerve as in tubercular leprosy. 

 The skin may become infected at an early or late stage of nerve 

 leprosy, thus forming one of the types of mixed leprosy. 



Fig, 733. — Leprosy: Ulcer of the Foot. 



