Modern medicine : its theory and practice, in original contributions by American and foreign authors . the skin shows the first evidence, this may appear either in explosivelesions, as bullae, in simple erythematous patches, or in exactly localizedareas of bacilli colonized in masses and forming tubercles. When the nerves are attacked, along the course of the nerve involved thereis either thickening of the sheath or of the nerve itself, or nodes of varying LEPROSY 127 size are formed. At the terminal ends of the branches of these nerves, skinlesions in the form of bullae, pigmentation
Modern medicine : its theory and practice, in original contributions by American and foreign authors . the skin shows the first evidence, this may appear either in explosivelesions, as bullae, in simple erythematous patches, or in exactly localizedareas of bacilli colonized in masses and forming tubercles. When the nerves are attacked, along the course of the nerve involved thereis either thickening of the sheath or of the nerve itself, or nodes of varying LEPROSY 127 size are formed. At the terminal ends of the branches of these nerves, skinlesions in the form of bullae, pigmentation, thickening or atrophy of theepidermis may appear or there may be actual neuritic changes in the muscles,tendons and bones. Skin leprosy presents its several lesions either separately or together at thesame time and while the macule often occurs as a preliminary eruption it maybe the sole evidence of the disease. So with the tubercles of leprosy. Thesemay appear at once or may develop upon the areas previously outlined bythe erythematous or macular eruptions. All of these lesions may occur Fm. Macules of leprosy. (Leloir.) together and again they separately or together are often found concomitantwith the nerve lesions and changes, which they may also precede or first evidences of skin or nerve leprosy are the bulhie, found upon theextremities, especially on the hands and feet. With skin leprosy these areusually small in size, numerous and superficial. They occur bilaterally andsymmetrically, usually on the dorsum of the hands and feet and especiallyover the fingers. They break quickly and dry, leaving a superficial erosionwhich heals spontaneously, and the site of the lesion is marked by a whitescar, usually with a pigmented and irregular border. 128 INFECTIOUS DISEASES Fig. fi. With nerve leprosy these lesions are more often single, large, and occurover the joints of the phalanges; as a rule they persist, even ulceratingdeeply at the point of origin. Even if he
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