. Internal medicine; a work for the practicing physician on diagnosis and treatment, with a complete Desk index. hich may run together and form largetuberculous masses. These tubercles are at first soft and elastic andslightly tender upon pressure: later they become firmer and are insensi-12 178 MEDICAL DIAGNOSIS. tive. They may develop upon any portion of the body. The scalp is,however,, usually exempt. They are most common upon the face, thedorsal surfaces of the hands and feet, upon the ankles, wrists, and forearms,and the outer aspect of the thighs. The lesions progressively involve new ar
. Internal medicine; a work for the practicing physician on diagnosis and treatment, with a complete Desk index. hich may run together and form largetuberculous masses. These tubercles are at first soft and elastic andslightly tender upon pressure: later they become firmer and are insensi-12 178 MEDICAL DIAGNOSIS. tive. They may develop upon any portion of the body. The scalp is,however,, usually exempt. They are most common upon the face, thedorsal surfaces of the hands and feet, upon the ankles, wrists, and forearms,and the outer aspect of the thighs. The lesions progressively involve new areas of skin with the forma-tion of fresh tubercular masses, and as the older ones undergo ulcerationareas of cicatrization form. These changes in the skin undergo their mostmarked development upon the face, producing the characteristic fades,leonina. The superficial lymphatics generally become enlarged early inthe course of the disease. The eyelashes and eyebrows fall out andthere is atrophy and loss of hair elsewhere upon the body. The hairyscalp is usually unaffected. The mucous membrane of the upper air-. FiG. 270.—Early stage of tuhr-rrMjlar leprosy.—German Hospital. Fig. 271.—Tubercular leprosy. passages undergoes infiltration, with the formation of tubercles. Thesespeedily break down, giving rise to painful ulceration. Changes in thevoice occur. It becomes harsh or nasal, or more or less completeaphonia may develop. As cicatrization takes place various deformities result, as stenosis ofthe mouth or palate, and laryngeal stenosis. The process involves theeyelids and extends to the ocular conjunctiva and the cornea, resulting inultimate destruction of vision in from 66 to 75 per cent, of the cases. The duration of the disease is indefinite. , The patient may livefor years, becoming more and more deformed and helpless. Deathcommonly results from exhaustion, colliquative diarrhoea, or inhalationpneumonia; sometimes from stenosis of the larynx or trachea or laryn-geal oe
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