SAJOUS.] Symptoms.—The earliest symptoms of leprosy in the majority of cases, accord ing to Morrow (who claims to have first called attention to the early evidences in the nasal mucous membrane) and other observers, are alteration of the voice, betrayed by a slight husky or rough phonation—Besnier's voix lepreuse —which he likewise considers an early sign; rhinitis, with an abnormally free nasal secretion, sometimes epistaxis, and an increase in the salivary secretion.
Leprosy is always chronic. At its onset nasal or cutaneous involvement is first observed. Of the internal organs, the lungs and the spleen are first affected; later, the liver and intestines; the kid neys very rarely. Albuminuria is uncom mon. The nervous system is frequently involved. Goldschmidt (La Lepre; Soc.
d'Ed. Scientif., Paris, '94).
Sticker noted that the nasal mem brane could appear normal in the first stage or at most show a slight increase of secretion. The first visible change is a simple dry catarrh in circumscribed patches, which eventually present a raw surface. In advanced cases shallow or deep ulcers are visible in one or both sides of the septum. Sometimes there is only a hard swelling, which may be extended to adjacent parts and produce stenosis.
Leprous lesions of the nasal fossa, the mouth, throat, and larynx found in GO Per cent. of the eas-es examined. Con clusions that chronic eoryza is often the first exterior manifestation of leprosy, and that the nasal mucus of lepers is of great virulence and constitutes one of the most efficient sources of the propagation of leprosy. Jeanselme and Laurens (Bull. Med., July 25, '97).
The systemic invasion of leprosy is usually slow, years rather than months constituting the period of incubation. Occasionally, however, its onset is sud den and the disease progresses rapidly. 'The prodrotnal symptoms are mainly those of .1.-Tetteral neurasthenia: anorexia, chilliness. slight ephemeral fever, mental inaptitude, etc. These manifestations
occur by exacerbations, and their re currence is attended by more or less marked impairment of sensibility and other cutaneous functions, perspiration, etc., over restricted areas, fugitive spots suggesting slight erythema.
There is an essential leprous fever due to the presence of the bacillus leprm or its toxins. This fever is always inter mittent, if uncomplicated. It may occur at any period of the disease, including the so-called prodromal period of some \\Titers, and may or may not be accom panied by an eruption. Since all forms of the disease (lepra) depend on the same organism, the fever probably occurs in all, although in varying degree. When fever of a. continued type is observed in leprosy, it is due to the presence of other toxins acting either with, or entirely apart from, those of the bacillus leprm. The essential fever of leprosy has little clinieal import beyond indicating that the disease is active and progressive. Lewers (Brit. Jour. of Derm., Oct., '99).
After the foregoing symptoms have shown themselves with varying activity at various times, receding as often with more or less rapidity and completeness, the erythematous spots become more per sistent, are more highly colored and sen sitive to the touch, and project beyond the surface to a greater degree. They are reddish-brow-n, gray, dark-yellow or bronze, and of varying, size from that of a dime to that of the palm. They may appear over any part of the body, the face, the trunk, and extensor portions of the limbs. After a time these spots also disappear, leaving a discolored patch, which in dark-skinned persons such as the residents of South American coun tries, appears white as compared to their surrounding-s.
[In some cases I bad occasion to see in Mexico the appearance of the patients suggested the spots on leopard skins. C. E. DE AL SAJOES.]