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SYMPTOMATOLOGY OF LEPROSY.* By Howard Fox, "Si. D., New York. As the number of lepers in New York city ap- pears to be slowly but steadily increasing, it would seem that a knowledge of the symptoms of the dis- ease is becoming of practical as well as of theoreti- cal interest to the profession of this city. In briefly presenting the numerous and varied .symptoms of leprosy it is most convenient to de- scribe the two distinct and classical types of the disease, namely, tubercular leprosy, in which the skin and mucous membranes are chiefly affected, and anaesthetic leprosy, in which the nervous sys- tem is principally involved. Macular leprosy is de- scribed by some writers as a third type of the dis- ease, and in a few cases the macules constitute prac- tically the only symptom. In most cases, however, they are simply forerunners of either the tuberetilar or an.TSthetic stages and need not be discussed as a separate type of the disease. In a large number of the cases there is a combination of symptoms constituting \\hat is called the mixed type of lep- rosy. Practically all of the cases seen in New York ,ire of the tubercular or mixed type, the cases of ])ure nerve leprosy being extremely rare. Indee 1, among thirty cases which I have seen in New York citv during the past year I can recall having seen I'.ut one case of pure anaesthetic leprosy presenting well marked deformities or mutilations. The symptoms of leprosy do not evolve with as much regularity as they do in syphilis for instance, and an artificial description of the stages of the dis- ease seems hardly warranted. We do not know in what manner the infection occurs, as there is no primary lesion in leprosy that is comparable to the chancre of syphilis. It is therefore difficult or im- possible to judge of the exact time crazy vegas slot game when a certain patient has become infected. This may be estimat- ed in certain cases in which, for instance, a person has resided for a short time in a leprous country and then returned to a nonleprous region and later presented the symptoms of leprosy. • The period elapsing betwen the time of infection and the first manifestations of the disease, the so called period of incubation, has no parallel as re- gards length of time with any other infectious dis- ease. Thus it may vary from three months to ten, twenty, or even thirty-two years, as in the case re- ported by Hallopeau. The question as to whether the period of incuba- tion represents a true germination of the bacilli, or only a long period of latency or hibernaticn, is cm that need not crazy vegas slot be discussed at this point. The general invasion of the body by crazy vegas slot review the bacilli or their poisonous products may be marked by a group of symptoms or prodromata, that are not in themselves in any way diagnostic of leprosy. They include a rise of temperature, which may be mild and gradual, or sudden and severe, as in pneumonia. The fever may he accompanied by general malaise, headache, vertigo, drowsiness, severe sweating, and various rheumatoid pains. The patient himself is apt to ascriiie such symptoms to a "bad cold" or an "Read before the New York Academy of Medicine, December 29. 1910. in a "symposium" on leprosy. FOX: SYMPTOMATOLOGY OF LEPROSY. 7^2, attack of malaria. These symptoms may be fol- lowed in a few days by characteristic signs of lep- rosy, or the latter ma\ not appear for many months, or even a year or more. It is, therefore, not re- markable that after a considerable lapse of time these early svmptoms should have been entirely for- gotten, especially by crazy vegas slot casino the more ignorant class of pi- tients. As a matter of fact, there are numerous cases, especially of the anaesthetic type, in which tlie prodromal symptoms are entirely lacking. A verv earlv symptom which is observed in many cases, especially of the tubercular crazy vegas slot machine type, v: a persis'.- ■cnt rhinitis, with repeated mild attacks of epistaxis. This is thought bv some to be as valuable a diag- nostic sign as the haemoptysis of early pulmonary t'lberculosis. If, in addition, the bacilli can be de- monstrated in the nasal secre- tion an early positive diagnosi- can of course be made. The onset of leprosy may be characterized by various sen^- •ory, vasomotor, and trophic disturbances that may or may not be associated with the pro- or weeks the early erythema- tous eruption disappears and may reajjpear later, accom- panied by fever and other gen- eral symptoms, .\fter several repeated attacks in such a case the macules become permanent or "fixed," their color deepens, and does not tend to disappear on pressure. In many cases, free crazy vegas slots especially of the anaesthetic type, the macules make their appearance insidiously, without any constitutional symptoms, crazy vegas online slots and are fixed and pig- mented from the outset. In the majority of the cases, certainly as we see them in New York, the macules have become permanent bv the time medi- cal aid is sought. The macules vary in size from a pea to that of the palm of the hand, or may occupy large areas of the body, especially in the anaesthetic type. Their borders may be sharply or poorly defined. They

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