The extensor surfaces of the forearms, thighs and buttocks are also favorite sites for the indurated spots. The palms of the hands, soles of the feet, hairy scalp, groin and axillary regions are almost never attacked. These spots may be hyperaesthetic at first but soon show loss of pain and temperature sense with retention of touch sensation (dissociation of sensation). These spots do not sweat, they remain dry even in a general perspiration. Following successive febrile accessions and reappearances of spots we have developed reddish-brown nodular masses, usually on the sites of the spots. When the nodules are grasped between the fingers one usually finds them elastic to touch. As the result of active sebaceous secretion these nodules have a greasy appearance. These protruding nodules may give the face a leonine appearance, hence the name leontiasis, or that of a satyr, hence satyriasis. With the development of the nodules the hair falls out of the eyebrows and bearded face. Nodules develop in the mucous membranes of the nose, mouth and larynx, giving rise to foetid discharges and obstruction of the nares, difficulty in mastication as well as in breathing and a raucous voice. The eye is involved with frightful frequency in this form of leprosy, there being infiltrations of the eyelids, conjunctivae, cornea and iris, with subsequent ulcerations and loss of sight. The nodules on face, backs of hands, buttocks, etc., may disappear by resolution but the tendency is for them to ulcerate and produce various contractions and deformities. [Illustration: FIG. 78.—Nodular leprosy. Advanced stage with ulceration. Leontiasis. (Van Harlingen.)] The glands in the region of the lesions become enlarged but do not tend to suppurate. Visceral involvements are not common but serious lesions of the liver have been reported. The course of the disease is essentially chronic and if some intercurrent affection does not carry off the patient, the end comes in a cachexia in about ten years, the temperature gradually falling and a state of somnolence ushering in the end. When nerve leprosy sets in upon a nodular type the life of the patient seems to be prolonged. Nerve Leprosy _A Typical Case._—The prodromal manifestations are characterized by the results of irritation of the granulomatous tissue upon the nerve fibers and are chiefly neuralgic pains or signs of sensory disturbances as formication, paraesthesias, etc. In particular, are the ulnar, peroneal and facial nerves attacked, the process very rarely extending above the knee or elbow. [Illustration: FIG. 79.—Nerve leprosy. Perforating ulcer of the foot. (U. S. Naval Medical Bulletin.)]