16 
The Philippine Journal of Science 
1919 
Plate II 
Fig. 10. Showing a not uncommon condition in leprosy, in which the 
nodules themselves undergo necrosis with subsequent absorp- 
tion, leaving smooth cicatrices. Necrosis of the cartilage of 
the left ear and of one nodule on the left cheek is here in 
progress. 
11. Showing the partial coalescence of large nodules on the cheeks 
and chin; this condition in advanced cases of leprosy gives rise 
to the leonine facies. 
12. A profile view of a case of early leontiasis, showing a diffuse 
thickening of the skin of the face. This is an excellent example 
of pendulous ear lobules. 
13. A slightly more advanced case of leontiasis, showing the loss of 
the normal lines of expression of the face, notably in the 
distorted lips. 
14. A still farther advanced case of leontiasis; the general thickening 
of the tissues of the face has given rise to a “death-masklike” 
appearance. Leprous cachexia is well marked in this woman. 
15. A fairly typical case of leontiasis. This may be considered as 
the terminal manifestation of uncomplicated nodular leprosy in 
the face. 
16. A typical “ring and little finger deformity,” the earliest recogniz- 
able deformity of this type of leprosy in the hands. Both fingers 
can be straightened with only moderate force and at this stage 
retain some function. 
17. A moderate contraction in all the fingers in leprosy; both thumbs, 
in this case, appeared to be normal. At the instant the picture 
was being taken, a moderate pressure was being exerted on the 
fingers to show the approximate amount of available extension. 
Plate III 
Fig. 18. A more nearly complete contraction of the fingers than in fig. 
17; here, too, the limit of extension is shown. The oedema 
present in the fingers of the left hand is transient and is due 
to an infection in the palm of the hand. 
19. An example of the claw hand of leprosy, the classical main en 
griffe; the typical atrophy of the interossei is indicated in the 
left hand. The condition of this hand may be considered as 
the terminal manifestation of anaesthetic leprosy of the hands 
in uncomplicated cases. Unfortunately, the disease rarely stops 
with this deformity. Due to the coincident anaesthesia, the 
hands are subject to trauma, particularly to burns, which may 
be very extensive and are usually painless. Other trauma and 
neurotrophic changes result in various deformities. 
20. The typical perforating ulcer of the foot; this lesion is considered 
by the natives in many parts of the world as diagnostic of 
leprosy. 
21. The typical, sluggish, neurotrophic ulcers of leprosy, which 
although almost incurable appear to have a strong resistance 
to the ordinary pyogenic infections. The curious parchmentlike 
skin frequently seen among anaesthetic lepers is shown. 
