MACULO-ANMSTHETIC LEPROSY 



Mixed Leprosy. 



This term has been used to comprise those cases of tubercular 

 leprosy which develop nerve symptoms, and those of maculo- 

 anaesthetic leprosy which develop nodules, as well as those general 

 cases in which both nerve and skin lesions advance hand in hand. 



Paraleprosis. 



Zambaco, Von Duhring, Gliick, Leboeuf, and others have drawn 

 attention to various phenomena indicating an attenuated in- 

 fection in regions in which leprosy has long existed. These 

 conditions are mostly nerve or trophic changes — e.g., thickening of 

 the ulnar nerve, the curving of the fingers, the loss of phalanges, the 

 atrophy of the muscles of the hand or face, which are present in the 

 children or grandchildren of lepers. Further, it is believed by some 

 authors that syringomyelia and Morvan's disease may be modified 

 forms of leprosy. Paraleprosis, however, requires further investiga- 

 tion. 



Complications. — The important complications of leprosy are 

 nephritis, phthisis, chronic enteritis, and dysentery. Amyloidosis 

 occurs in the internal organs if there is much discharge from 

 ulcerated surfaces. An interesting case of mixed infection — 

 leprosy and syphilis — has been described by Fragoni. 



Diagnosis. — The diagnosis of cafes of the nodular type is generally 

 easy, and may be readily confirmed b act eriologic ally by excision of 

 a nodule and microscopical examination of a portion for Hansen's 

 bacillus. The diagnosis of the maculo-anaesthetic cases presents 

 greater difiiculties, especially as in most cases the bacteriological 

 examination of excised portions of the patches will give a negative 

 result, though occasionally the examination of the blood taken from 

 the patches or the surrounding zone may show a few mononuclear 

 leucocytes containing bacilli. In these cases the diagnosis must 

 be based on the presence of anaesthesia in the er}d:hematous, non- 

 pigmented, or hyperpigmented patches. Another valuable sign 

 will be, in many cases, the palpable enlargement of the ulnar, 

 peroneal, and other nerves. The search for the lepra bacillus in 

 the nasal mucus is sometimes useful to clear the diagnosis. This 

 method of diagnosis may be facilitated by administering a full dose 

 (30 grains) of iodide of potassium, which often produces nasal catarrh. 

 Sometimes this drug produces a general reaction accompanied by 

 fever, and the appearance of fresh nodules. Leboeuf, acting on 

 Marchoux's suggestion, has found Hansen's bacillus in the enlarged 

 superficial lymphatic glands, and recommends the examination of 

 the gland juice as a method of diagnosis. It is to be noted, how- 

 ever, that this examination will give a positive result much more 

 frequently in nodular cases than in the macular type of the disease. 



Chujo recommends drawing 5 c.c. of blood from the arm, diluting it with 

 200 c.c. of a 3 per cent, solution of acetic acid, avoiding contact with the air. 



