Page:Tropical Diseases.djvu/671

XXXVI] live, the nerve trunks are attacked, and then the neuralgic, paretic, and trophic lesions of nerve leprosy are superadded. The fingers and toes ulcerate and drop off, or they become distorted and atrophied; or the phalanges are absorbed, the hands and feet becoming reduced to useless stumps. A peculiar goat-like smell is emitted by the ulcerating, decaying body. Altogether, the blind, lame, and unhappy wretch— still retaining his intellect, but devoid of every sense except that of hearing, breathing with difficulty through a stenosed larynx, and racked by neuralgic pains and irregular outbursts of fever— comes to present, before the inevitable death from exhaustion occurs, a sadder, more loathsome, and more repulsive picture than anything imagination could conceive. Fortunately, in a large proportion of cases, the leper is mercifully carried off by phthisis, pneumonia, or some intercurrent affection at an earlier period, and before his disease can be said to have run its full course.

Just as in nodular leprosy, in nerve leprosy the prodromal and macular stages may be severe, or slight, or altogether absent. Usually, however, in nerve leprosy, much more frequently than in nodular leprosy, the ulterior and more distinctive lesions are preluded by a long and well-marked macular stage, during which large areas of skin are occupied by erythematous (Fig. 86), by pigmented, or by vitiliginous patches. The ringed form of eruption is a very usual one; a red, congested, slightly elevated and, perhaps, hypersesthetic border enclosing a larger or smaller area of pale, anæsthetic, non-sweating integument the whole resembling somewhat one of those extensive body-ringworms so common in natives of hot, damp climates, and for which these rings are sometimes mistaken. Such eruptions may come and go, or they may be permanent, or they may spread and multiply during many years before the more distinctive and graver signs of nerve leprosy are evolved.