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surface of the reddened spots is often oversensitive.







After a period ranging from weeks to years, tubercles rise from the spots

described, varying in size from a pea to that of a nut, and they may be as

large as a tomato. They are in color, yellowish, reddish-brown, or

bronzed, often shining as if varnished or oiled, are covered with a soft,

natural, or slightly scaling outer skin, roundish or irregular in shape

and are isolated or grouped numbers of very small and ill-determined

nodules may often be seen by careful examination of the skin in the

vicinity of those that are developed. They may run together and cause

broad infiltrations and from this surface new nodules spring. They may be

in the skin or under the skin and feel soft or firm. The eruption of these

tubercles is usually preceded at the onset by fever, as well as by puffy

swelling of the involved region, eyelids, ears, etc. These leprous

tubercles choose the face as their favored site. They mass here in great

numbers, and thus produce the characteristic deformity of the countenance

that has given to the disease one of its names, Leontiasis (lion face).



In such faces the tubercles arrange themselves in parallel series above

the brows down to the nose, over the cheeks, lips and chin, and as a

result of the infiltration and development of the conditions the brows

deeply over-hang; the globes of the eyes, and the ears, are so studded

with tubercular masses as to stand out from the side of the head. The

trunk and extremities, including the palms of the hands and soles of the

feet, are then usually involved to a less degree. The arm-pit, genital and

mammary regions, and more rarely the neck and the palms of the hands and

soles of the feet, may be invaded. In occasional cases when the

development of tubercles upon the face and ears is extensive, there may

not be more than from five to fifty upon the rest of the body, and these

either widely scattered and isolated or agglomerated in a single hard,

flat, elevated plaque of infiltration upon the elbow or thigh. When the

tubercles run together (become confluent) large plaques of infiltration

may form, which are elevated and brownish or blackish in color.



The soft palate and larynx are often involved when the skin lesions are

present. The voice may sound gruff and hoarse, and the tongue, the larynx

and soft palate have been found studded with small sized, ashen-hued

tubercles. These tumors or tubercles may degenerate and form into

irregularly outlined, sharply cut, glazed ulcers, with a bloody or

sloughing floor, or they may disappear and leave behind pigmented,

shrunken depressions, or they lose their shapes from partial resorption. A

large plaque may flatten in the center until an annular disk is left to

show its former location. Coincident symptoms are disturbance in the

functions of the sweat and sebaceous secretion, thinning and loss of hair

in the regions involved, especially the eyebrows, and disorders of

sensibility. Later results, are a nasal catarrh, atrophy of the sexual

organs in both sexes, with impairment or loss of procreative power,

hopeless blindness. However the course of the disease is very slow, and

years may elapse before these several changes are accomplished. Often the

disease appears quiescent for months at a time, after which fever occurs

and with it acute or sub-acute manifestations appear, including gland

disease, orchitis, ulcerative processes, slow or rapid, followed by

gangrene and a relatively rapid progress is made toward a fatal

conclusion.



Toward the last the mutilations effected by the disease may result. Parts

of the fingers or toes, whole fingers or toes, and entire hand or foot may

become wholly or partially detached by the ulcerative and other

degenerations. This stage of this type of the disease may extend through

ten or more years. After it has fully developed the dejected countenance

of the leper, with his leonine expression and general appearance is highly

characteristic.