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XXXVI] anæsthesia becomes, as it were, settled in a part, it seems gradually to extend deeper into the tissues; so that after a time it is absolute, and the part may be pinched, incised, and even seared with fire, and the leper be absolutely unconscious of pain or even of being touched.

Step by step with the progress of the anæsthesia, atrophy of the subjacent muscles supplied by the thickened nerves proceeds. Along with the atrophy there is a corresponding distortion and a corresponding loss of power. There is no ataxia or incoordination of movement simply feebleness. Thus the forearm wastes, the grasp is weakened, the thenar and hypothenar eminences and the interossei melt

Fig. 87.—Nerve leprosy: main-en-griffe. (After Leloir.)

away, and the main-en-griffe or some such deformity is gradually produced (Fig. 87). Similar changes occur in the legs and feet, so that the power of walking is much impaired. The muscles of the thighs and upper arms, the pectorals, and the muscles of the face follow suit very much as in progressive muscular atrophy, only in the latter disease there is no superjacent anæsthesia.

In the affected nerve areas all the muscles are not simultaneously or equally attacked, so that, especially in the face, curious distortions may ensue. These facial atrophies, whether symmetrical or one-sided, in time produce a facies as characteristic of nerve leprosy as leontiasis is of nodular leprosy. Owing to muscular atrophy, the eyes, after a time,