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min and casts, but no lepra bacilli.
the changes in the kidney being
due to an ordinary nonleprous
nephritis. While the bacilli are
as a rule disseminated in the in-
ternal organs, especially the liver,
spleen, and bone derby dollars free marrow, they dderby dollars free slots the lesions are as a rule free from
lepra bacilli. "While the cutaneous eruption in
nerve leprosy," writes Morrow, "is not so essentially
a part of the morbid process as in tubercular lep-
rosy, the macules exhibit a greater variety of as-
pect, especially in their configuration and coloring."
They are more apt to persist and to cler^r up in the
centre and form vitiligoid patches, especially in the
dark skinned races. The hairs upon the macules
do not fall but are mere apt to become white.
The bullous eruption is more often encountere 1
in the early stage of the disease, the lesions varying;
in size from a split pea to a cherry. They ma\
appear upon any part of the body except the scalp.
but are seen upon the hands, elbows, knees, ankle-:,
and also the palms and soles. The bullse soon rup-
ture, dry, and form crusts followed by cicatrices.
The symptoms in general of the anas.sthetic typ
are those of a- peripheral neuritis causing various
sensory and trophic manifestations. In contras;
with the tubercular type of the disease which i-
characterized as von Bergmann says by marked h\-
perplasia, the noticeable changes in anaesthetic Up
rosy are those of free derby dollars slot machine atrophy.
One of the most important and diagnostic symp-
toms is an increase in the size of some of the nerve
trunks that occurs at a verj' early period of the
disease. The greatest changes derby dollar slot machine are observed in the
nerves that are superficially situated such as the
ulnar and median nerves. They are changed to
cylindrical or fusiform or beaded cords and may at
times attain the thickness of the little derby dollars slot finger. The-
ulnar enlargement is especially characteristic and
may at times be felt in its entire course from the
elbow to the axilla. At the outset, the nerve trunks
are painful upon pressure but later become com-
pletely insensible to pain.
The disturbances of sensation in leprosv may be
confined to the macules or exist independently of
them. The characteristic anaesthesia, which repre-
sents a complete disorganization of a nerve trunk,
is invariably preceded by irritative symptoms.
There is often hyperjesthesia which may be intense
or there may be pruritus, neuralgic, or shooting-
pains or various fon-ns of parassthesia. There mav
be vasomotor syn-iptoms such as cyanosis, or secret-
tory disturbances such as interference with sweat
Sooner or later anaesthesia makes its appearance,
and is especially marked in the extremities. It is
first noticed in the fingers and toes, and then trave'.s-
upward toward the trunk. It is often bandlike at
first, but later involves the entire circumference of
a limb. Part of the area of anaesthesia is fixed.
while the rest, according to Jeanselme, varies in
intensity from day to day. There is often diss-o-
ciation of sensation, that of temperature and pain
disappearing, for instance, while the sensation of
triuch remains. Sensation may also be delayed, as
when the prick of a pin is felt after an interval of
several seconds. The anaesthesia becomes com-
plete at last, so that the patient may be able to cut
off portions of the hands or feet without experi-
encing the slightest pain.
^Muscular atrophy is one of the constant and
striking symptoms of anaesthetic leprosy. There is
a diminution in force in proportion to the waste of
muscle tissue. .At times there is a true paralvs;?.