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Fig. 5. ā€” Nodular leprosy showing ulceration of lesions. Patient presented by Dr Howard Fo.x before the New York .U-ademy oi Medicine, December 29, 1910. FOX: SYMPTOMATOLOGY OF LEPROSY 7^7 Atrophy is noted at an early stage in the thenar and hvpothenar regions. From atrophy of the first dorsal interosseous a characteristic hollowing of the back of the hand is produced. One of the com- monest deformities is the "leper claw'" produced by tendinous retractions and muscular atrophy. It is formed by extension of the first and a flexion of the second and third phalanges. The palm is flat- tened and the thumb is on the same plane with the play deuces wild poker online free fingers. In spite of this deformity the use of the hands is far from being lost, especially if the sensa- tion of touch deuces wild poker game online remains. The superficial muscles of the face are frequently atrophied and can give the patient an appearance that is as characteristic as the leonine face of the tubercular leper. The eyes have a peculiar stare and the lids cannot be closed. The lips are flaccid and pronunciation of labials is difficult. On account Fic. 6. ā€” Nodular leprosy of three years' duration. Presented by Ilr. Howard l"o>: before the New Vork -Xcademy of Medicine. iJc cember 29, 1910. of eversion of the lower lip, saliva may flow from the mouth. The face becomes an expressionless mask, and the patient's appearance is stupid free deuces wild poker games online and doleful. In deuces bonus poker some cases the process of anaesthetic leprosy does not go beyond the production of muscular atrophy and tendinous retraction. In other case?, where the disturbance of nutrition is very great, there are bone changes which give rise to frightful mutilations. The loss of bone may occur from deuces wild online free ne- crosis or from a process of interstitial absorption. In tne case of the fingers the second phalanx is apt to be the first to disappear, so that the fingers ap- pear to have only two phalanges. In some cases Fig. 7. ā€” An;esthclic leprosy showing "claw hand" and ulceration. Patient presented by Dr. J. McF. Winfield before the New Vork play deuces wild video poker online Academy of Medicine, December 29, 1910. the nails are preserved with remarkable tenacity in spite of extensive loss of bone. Finally, the hands and feet become veritable stumps, the shape of the feet being compared to that of a pestle or drum stick. Large trophic ulcers, among them the so called perforating ulcers, may add to the patient's distress. The mucous membranes are much less often in- volved in the anjesthetic than in the tubercular type of leprosy. As the lower lid is everted the con- free online deuces wild bonus poker junctiva is unprotected and soon becomes inflamed. Corneal opacities may form and destroy the sight. Ulceration and destruction of the septum, with con- sequent sinking of the nose, deuces wild online video poker is not unccninion. Due to loss of tactile sensation there is often difliculty in swallowing, the food being regurgitated into the nostrils. The course of anaesthetic leprosy is decidedly chronic, the average duration of life being about fifteen \ears. In some cases the process appears to come to a stnnd^till and the patient iĀ« nppareiitlv -i8 XEir MAYER: SCHOOL NURSE. cured. A number of such cases have been re- ported bv Dyer, of New Orleans. In a few cases the anesthetic type changes to the tubercular form of the disease. The termination of a severe case of anaesthetic leprosypresents a totally different picture from that of the tubercular type, but one that may be equally pitiful and distressing. The aniesthetic leper is emaciated and cachectic. He is bedridden and has to be fed by attendants. The nose is sunken, the sight is extinguished, and saliva pours from the paralyzed lips. The patient suffers from a sense of cold, loss of appetite, insatiable thirst, and severe n,.niralgic pains. The numerous ulcerations add to the natural disagreeable odor of the leper and the deformities of the limbs make them scarcely rec- free online deuces wild card games ognizable as those of a human being. The patient's mind is dull, but by no means lost. Death is gen- erally due to marasmus, amyloid degeneration of the viscera, diarrhcea. or to an intercurrent disease. It is rarely due to pulmonary tuberculosis. 6i6 Madisox Avenue. EVIDEXCES THAT THE SCHOOL XURSE PAYS* Bv S. W. Xewmayer, M. D., gamehouse online games deuces wild Philadelphia, In Charge of Child Hygiene. Department of Public Health and Charities. When the secretary of this free online deuces wild poker association assigned to me this subject, my first thought was how ridic- ulous to be asked to furnish proof of a self evident fundamental fact. One may as reasonably ask "should public schools exist" ? Eight years' intimate association with the work of school nurses had made to bonus deuces 2 me schools, medical inspection, and school nurses synonymous. I considered them the tripod of edu- cation. When I began to gather information free online deuces wild video poker to furnish deuces wild poker msn games free online games you with a voluminous and convincing stat- istical report, I was reminded of Emerson's terse expression : "If you are struck by lightning, do not say anything about it." From the difficulty in obtaining reports about school nurses, one would surmise that the cities having play deuces wild online game them have deuces wild online been struck by lightning. They have been so stunned by the excellent results that the\' bonus deuces are speechless, or another case of exploiting our deuces wild online free game shortcomings but not our success. Few cities can give one a correct statis- tical report on anything pertaining to the physical conditions of the pupils, because the systems of keeping records are faulty. I believe, however, I can furnish sufficient convincing evidences in favor of school nurses, that you will agree with me that if medical inspection with nurses were placed on a scales counterbalanced by medical inspection only, the nurses' end would come down so hard that it \v onld go through the floor. To consider whether school nurses pay, we can consider it from the side of economy and from in- creased efficiency. One fifth of the entire popula- tion of the United States is enrolled in the public schools. Salaries paid to teachers are more than two hundred millions of dollais. The total ex- penditures for public education require a taxation deuces wild online game

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