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622 are, as a rule, clinically fairly distinguishable. It is customary, therefore, to describe them separately.

This form of leprosy often appears without a well-marked preliminary macular stage, being ushered in, after a longer or shorter prodromal stage, by a smart attack of fever and the rapid development on

Fig. 85.—Nodular leprosy. (After Leloir.)

the face or elsewhere of the specific lesion. In other instances a well-defined but, in comparison with nerve leprosy, short macular stage precedes the appearance of the characteristic lepromata (Fig. 85).

The essential element in nodular leprosy is the leproma. The dimensions, the combinations, the situations, the growth, and the decay of this give rise to the more manifest symptoms of the earlier stages, at all events, of the disease. The leproma, which will be more fully described in the section on