. A practical treatise on diseases of the skin, for the use of students and practitioners . 426 DISEASES OF THE SKIN* plaque flatten centrally till an annular disk was left to indicateits former site. It should he borne in mind, however, that the course of thedisease is exceedingly slow, and that years may elapse beforethese several changes are accomplished. The disease, indeed,often appears to he quiescent for months at a time, after whichwith the occurrence of fever, acute or subacute manifestations Fig. 43. Fig. 44. I. Larynges of lepers afiected with lepra tuberculosa. (Elsbergs appear and
. A practical treatise on diseases of the skin, for the use of students and practitioners . 426 DISEASES OF THE SKIN* plaque flatten centrally till an annular disk was left to indicateits former site. It should he borne in mind, however, that the course of thedisease is exceedingly slow, and that years may elapse beforethese several changes are accomplished. The disease, indeed,often appears to he quiescent for months at a time, after whichwith the occurrence of fever, acute or subacute manifestations Fig. 43. Fig. 44. I. Larynges of lepers afiected with lepra tuberculosa. (Elsbergs appear and a relatively rapid progress is made toward its fatalconclusion. Long before the latter is reached there are usually,in tubercular leprosy, intermingled symptoms of anaesthetic type,such as the occurrence of bullae or of anaesthetic patches withand without pigmentation. Toward the last, the mutilationseffected by the disease may result (lepra mutilans). Phalangesof the fingers or toes, whole digits, an entire hand or foot maythen become partially or wholly detached by ulcerative, atrophicor other degenerations of skin, bones, and ligaments, hastenedor not by intercurrent attacks of lymphangitis, erysipelas, sep-ticaemia, and irritative fever. The stadium of this type of the disease may extend throughten or even more years. After its full development, the pecu-liarly dejected countenance of the leper with his leonine faciesand general appearance of cachexia, are highly characteristic. Lepra form of th
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