Page:Tropical Diseases.djvu/676

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630
LEPROSY
[CHAP.

cannot be closed; the upper lid droops, the lower lid becomes everted, and the eye itself may become fixed. At first, owing to exposure of the organ, there is lacrimation; but by and by the secretion of tears dries up, the congested conjunctiva becomes cornified, the cornea ulcerates or turns leucomatous, and in the end sight is entirely lost. Ulceration often occurs in the mucous membrane of the nose, the septum being destroyed as in the nodular form; the tip of the nose may then fall down or be entirely lost. The lips, too, may become paralysed, thereby interfering with articulation and permitting the saliva to dribble from the mouth in a constant stream. Changes occur, also, in the mucous membrane of the mouth; the gums may retract, exposing the maxillary bone, the teeth ultimately dropping out. Anæsthesia of the tongue and buccal mucous membrane, and implication of the muscles of mastication, may render eating and articulation very difficult.

In time the skin of anæsthetic patches on the limbs tends to atrophy; it loses its glands and hairs, and, in the end, may become so thinned and tense that it actually bursts into long cracks. The nails are not generally shed, but they become rough, or thinned, or atrophied into minute, hook -like appendages. Ulcers form over exposed parts of the hands and feet. They may penetrate and disorganize the joints, and thus often cause fingers and toes to drop off, one after another. Or, perhaps, an abscess forms around a phalanx, destroys the periosteum, and ultimately leads to loss of the bone. Or a sort of dry gangrene may amputate finger or toe. Or there may be a curious interstitial absorption of one or more phalanges, the shaft of the phalanx wasting more rapidly than the articulating surfaces. In any of these ways the fingers and toes are distorted or destroyed. It is no unusual thing to see on a leper's hand a finger in which one or more of the phalanges have been thus got rid of without destruction of the fieshy part, or with only a general shrinking of this. Thus it comes about that a distorted, talon -like nail may crown a finger which is a mere stump; or, the