Page:Tropical Diseases.djvu/667

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XXXVI]
THE PRIMARY ERUPTION
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fresh spots appear, they tend to greater permanency, to be more liable to pigmentation, and are partially or wholly anæsthetic from the outset, or subsequently become so.

A striking feature of this and of all leprous eruptions is the loss of the hair in the affected areas. Another striking circumstance is the fact that the most hairy part of the body, the scalp, is never or very rarely affected either with leprous eruptions or with leprous alopecia. As the face, particularly the superciliary region, is prone to all forms of leprous eruption, falling of the eyebrows is a very usual, very early, and very characteristic phenomenon. The beard, too, is apt to be patchy, particularly in nodular leprosy. In many instances, before they drop out, the individual hairs become white, or downy, or splintered, or monillated.

The most frequent seats of the primary macular eruption are the face, especially the superciliary region, the nose, cheeks, and ears; the extensor surfaces of the limbs; the backs of the hands; the back, buttocks, abdomen, and chest. The palms of the hands and the soles of the feet are rarely if ever attacked. At this stage of the disease the mucous membranes are very rarely affected.

In the distribution of the maculæ a rough symmetry may or may not be discernible.

5. The period of specific deposit.— During the stage just described, if there be any thickening of the skin or other evidence of new growth, it is barely perceptible to sight and but slightly so to touch. Sooner or later, however, another stage is entered on, a stage characterized by the deposit or, rather, growth of a tissue possessing well-marked specific characters. This deposit occurs either in the skin, or in the continuity of the peripheral nerve trunks, or in both. If in the first situation, nodular or, as it is sometimes called, tubercular leprosy is the result; if in the second, we have nerve or anæsthetic leprosy; if in both of these situations, then what is known as " mixed leprosy " is produced. These three forms of the completely developed disease, though having much in common,