File:Medical diagnosis for the student and practitioner (1922) (14598042180).jpg

Identifier: medicaldiagnosi00gree (find matches)
Title: Medical diagnosis for the student and practitioner
Year: 1922 (1920s)
Authors: Greene, Charles Lyman, 1862-
Subjects: Diagnosis
Publisher: Philadelphia, Blakiston
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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Text Appearing Before Image:
ness of its stagess to the development of syphilis. The initial lesion is believed, by some author-
ities, to be represented by an ulcer or excoriation on the nasal septum.
There is a prodromal stage resembling the second stage of syphilis in that it is
associated with transient fever, headache, joint pains, and commonly with
epistaxis, possibly due to the septal ulceration, and after several months or

LEPROSY 1121
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even a year or two a febrile paroxysm is accompanied by macular eruptions.
The circumscribed erythematous patches are generally distributed, chiefly
affecting the back of the hand, the forearm, the face, the malar and supra-
orbital regions being especially affected, the scalp usually spared.
The macules may be hyper esthetic early, but later become anesthetic, either
centrally or wholly. They are at first transient, but tend to become per-
sistent and pigmented. Without further advance they may show a loss of
pigment and then constitute the dead white, shiny areas of "white leprosy."
Text Appearing After Image:

Fig. 540.—Macular anesthetic leprosy. (Deycke.)

A definite third stage is represented by three forms, the nodular or tubercular,
the anesthetic, and the mixed.

Nodular leprosy may lack the macular stage and the subcutaneous tubercles
are flat, hard and elastic to the touch, and most numerous about the ears and
face. Their increase in size and the infiltration of the affected parts produces
the leontine fades. With occasional disappearance and reappearance in
individual areas, they nevertheless multiply and ultimately involve the
greater portion of the body and mucous membranes and break down into
ulcers which discharge hosts of bacilli and bacillary emboli and cause horrible
deformities from tissue loss and cicatricial contraction.

Anesthetic Leprosy.—This is characterized by an extensive painful
neuritis due to direct invasion of the nerves by the bacilli. Extensive anes-
thesia results, associated with bullae, spreading ulceration, and subsequent
contractures. Muscular atrophy is widespread, and fingers and toes may be
completely destroyed.

71

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