Page:Tropical Diseases.djvu/670

624 applies to the legs, where the infiltration is usually dusky, diffuse, ill defined, and prone to ulcerate.

From time to time, and at longer or shorter intervals, fresh lepromata appear, their formation generally concurring with an outburst of fever. Occasionally—and this is very often observed during an intercurrent attack of some acute disease, such as an exanthematous fever, or erysipelas, or even of some exhausting disease like phthisis— all or a proportion of the nodules are temporarily absorbed, leaving only slight traces behind. But the normal and usual fate of the nodule is either first to soften in the centre and then to be absorbed, leaving a smooth circular patch of scar tissue; or, after softening, to ulcerate and discharge a sticky, yellowish pus. This discharge tends to dry up into crusts, ulceration proceeding underneath. Finally the ulcer may heal, leaving an irregular, depressed scar.

When the septum of the nose is affected, the cartilage breaks down, the tip of the organ becomes depressed, and a stinking discharge escapes from the nostrils. In such circumstances breathing is very much interfered with, more especially if, at the same time, leprous deposit occurs or ulcerates in or about the glottis, the epiglottis, pharynx, tongue, or mouth generally. The senses of smell and taste are then lost for ever.

The eyes, also, are sooner or later attacked, lepromatous growth spreading from the conjunctiva on to the cornea or into the anterior chamber, or originating in the iris or ciliary body. Ultimately these organs also are destroyed.

Thus, in time, with the exception of that of hearing, one sense after another is lost. Ulcers form everywhere from the breaking-down of the nodules or from injuries to the insensitive skin. The cervical and inguinal glands, owing to leprous infiltration, swell and perhaps suppurate and become fistulous; the abdomen enlarges from leprous, perhaps combined with amyloid, infiltration of the liver, and there may be diarrhœa from amyloid disease of the intestine. In addition to these troubles, if the patient