Leprosy : $b in its clinical & pathological aspectsHansen, G. Armauer (Gerhard Armauer)
Science
Leprosy : $b in its clinical & pathological aspects
Hansen, G. Armauer (Gerhard Armauer)
Leprosy
The leprous nodes or nodular Lepromata are of different size and
colour; their consistence is at first firm and hard; they are but
slightly compressible, and show little elasticity. Their form is
usually semi-spherical, but they are often oblong. The smallest
nodule that we have seen was not more than 1-2 mm. in diameter, and
its appearance was so little characteristic, that we had to confirm
the diagnosis by excision and microscopical examination. The larger
the nodules, the more characteristic is their appearance. As they are
almost always seated in the cutis, the epidermis over them is stretched
and shiny; it is occasionally normal in colour, but usually at first
reddish, later becoming yellow. _The localisation of the nodules is
usually characteristic._ They are generally first evident on the face,
on the backs of the hands, and on the dorsal surfaces of the wrists,
and next on the extensor surfaces of the limbs. They are more rarely
seen on the back and nates; on the flexor surfaces of the extremities,
on the breast, abdomen, scrotum, and penis, they are quite exceptional;
and we have never seen them on the glans penis, the palms or soles, or
on the hairy scalp. Leloir has described a leprous affection of the
palms of the hands, of which he himself says that it closely resembled
a syphilide in that situation. Since Danielssen, with his enormous
experience, never saw a leprous affection of the palm of the hand, we
incline to believe that the affection which Leloir observed, not only
resembled, but actually was, a syphilide.
Here in Norway where the people often go barefoot, wading in streams,
marshes and rivers, the backs of the feet and the under part of the
calves are frequently the seat of the first leprous eruption, not so
often in the form of nodules, as of a dense, regular infiltration.
Now since, as we have noted above, the face and back of the hands are
the usual seats of predilection for the earliest appearance of the
eruption, it appears not improbable that this has its explanation in
the climatic influences on these parts, possibly influenced by the
structure of the skin, especially the cutaneous vessels. That there
are peculiarities in the structure of the tissues, which determine the
localisation of the poison, one may conclude; for certain organs are
never affected with leprosy, in spite of the fact that the poison has
evidently at some time circulated in the blood.
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