A frequent and very distinctive symptom of. this type of the disease, occurring often about this time, is the sudden appearance of bullee (pemphigus leprosus)—one or more or a series of them— on the hands, feet, knees, backs of thighs, or elsewhere. These bullæ vary in size from a pea to an egg. After a few days they rupture, exposing a reddish surface which presently crusts over, exfoliates, and finally turns into a pale, perhaps anæsthetic spot with a sharply defined, pigmented border. More rarely the site of the bulla ulcerates. Should similar bullse be formed in the neighbourhood of the first, the resulting ulcerations may unite into an extensive, probably superficial, serpiginous-looking sore.
A time comes when evidence of profound implication of the nervous system, in the shape of severe neuralgic pains, formication, hyperæsthesia, or anæsthesia, becomes more accentuated. The lymphatic glands enlarge, and there is often considerable fever and general distress. Hitherto the most prominent symptoms have been the skin lesions. These may remain or even increase; on the other hand, they may in part or entirely disappear. But whether the skin lesions increase or retrograde, evidences of profound implication of the peripheral nervous system now distinctly show themselves; the neuralgic pains still further increase, and hyperæsthesia, aæesthesia, and various paræsthesiæ, along with trophic changes in skin, muscle, and bone, the results of nerve destruction, become the dominating elements in the case.
If at this stage the ulnar nerve where it passes round the internal condyle of the humerus be examined, generally it will be found to be the seat of a fusiform swelling, perhaps as thick as the little finger. Other nerves, such as the anterior tibial, the peroneal, more rarely the median, radial, brachial, and cervical nerves, especially where they pass over a bone and lie close under the skin, can be felt to be similarly swollen. Occasionally even the smaller nerves, where superficial, can also be detected hard and cord-like. At first these thickened nerves are tender on pressure, and the parts they supply may be the seats
