TUBERCULAR FORM. — It iS thiS form that the naso-pharyngeal nomena are most marked. The patient experiences slight difficulty in breathing through the nose and the symptoms taining to the air-tract already described become quite marked. Then comes the period during which the cutaneous lepro mata of Leloir are formed. Localized nodosities appear over various reg,ions,— the face and hands ing in size from small shot to a chestnut.
The skin appears much thickened, ened, and puckered, wrinkles being turned into deep furrows; the hairs are often changed in color and fall out.
The projecting portions of the head— the nose, chin, and ears—taking part in the thickening, the face acquires a char acteristic expression which fully accounts for the horror inspired by these wretched cases. The extremities, especially the hands and feet, are generally affected in the same way. Their skin being thick ened and furrowed, they stand out stiffly and are used with difficulty.
The thickened areas, or "tubercles," do not all follow the same course. Some recede, leaving a depressed or less pig mented spot, while others proceed to ulceration. These ulcers are usually small, vary in depth, and their borders, as in the case of syphilis, are sharp-cut and have indurated edges. They heal and reappear several times in succession. When the ulcerative process invades the deeper tissues, they destroy them; cles, tendons, and even bone yield to its ravages; hence the mutilating effects of the disease. The mucous membranes of the mouth, tongue, pharynx, and larynx take part in the destructive process. The nasal bones and cartilages are markedly involved: the typical "saddle nose," in dicating destruction of the supporting frame-work. A sniffling respiration in
dicates more or less complete obstruction to the respiration, by- neoformations or depressed soft tissues.
Laryngeal examination of a series of cases of leprosy. In one the entire larynx was involved; the epiglottis was com pressed laterally and curved backward; the vocal cords were covered with numerous round nodules; the mucous membrane of the subglottic space was thickened and pigmented, as was that of the aryteno-epiglottic ligaments. A sec ond case showed diffuse generalized pig mentation and a small number of nodules. In a third case the larynx was filled with nodules, occupying especially the free part of the epiglottis; the superior vocal cords were irregular and the inferior left cord thickened. In a fourth the laryngeal mucous membrane was almost entirely destroyed, the ventricle and vocal cords were covered with many nodules, and there was considerable ulceration of the lower part of the cords. In a fifth case the internal surface of the larynx was completely destroyed, and in the sixth there was diffuse hypertrophy of the en tire mucous membrane, but no nodules. Bergengrfin (Univ. Med. Jour., Apr., '94).
Tubercular leprosy progresses slowly: eight or ten years, on an average. It is attended by eruptive and febrile ex acerbations, each being 'followed by a period of comparative quiet. Gradually, however, the patient succumbs through invasion of the viscera, and death usu ally follows some intercurrent disease: pneumonia, pleurisy, etc.