Lepra Tuberosa. (Tuberculated, Nodulated or Tegumentary (skin) Leprosy).—­ This nodular type comprises from ten to fifty per cent of cases.  After the occurring of the symptoms just mentioned spotted lesions appear, which are bean to tomato in size, reddish brown or bronze-hued patches, roundish, oval or irregular in contour, well defined, and they occur upon the face, trunk and extremities.  The skin covering them is either smooth and shining, as if oiled, or is infiltrated, nodulated and elevated.  The surface of the reddened spots is often oversensitive.

[Infectious diseases 239]

After a period ranging from weeks to years, tubercles rise from the spots described, varying in size from a pea to that of a nut, and they may be as large as a tomato.  They are in color, yellowish, reddish-brown, or bronzed, often shining as if varnished or oiled, are covered with a soft, natural, or slightly scaling outer skin, roundish or irregular in shape and are isolated or grouped numbers of very small and ill-determined nodules may often be seen by careful examination of the skin in the vicinity of those that are developed.  They may run together and cause broad infiltrations and from this surface new nodules spring.  They may be in the skin or under the skin and feel soft or firm.  The eruption of these tubercles is usually preceded at the onset by fever, as well as by puffy swelling of the involved region, eyelids, ears, etc.  These leprous tubercles choose the face as their favored site.  They mass here in great numbers, and thus produce the characteristic deformity of the countenance that has given to the disease one of its names, Leontiasis (lion face).

In such faces the tubercles arrange themselves in parallel series above the brows down to the nose, over the cheeks, lips and chin, and as a result of the infiltration and development of the conditions the brows deeply over-hang; the globes of the eyes, and the ears, are so studded with tubercular masses as to stand out from the side of the head.  The trunk and extremities, including the palms of the hands and soles of the feet, are then usually involved to a less degree.  The arm-pit, genital and mammary regions, and more rarely the neck and the palms of the hands and soles of the feet, may be invaded.  In occasional cases when the development of tubercles upon the face and ears is extensive, there may not be more than from five to fifty upon the rest of the body, and these either widely scattered and isolated or agglomerated in a single hard, flat, elevated plaque of infiltration upon the elbow or thigh.  When the tubercles run together (become confluent) large plaques of infiltration may form, which are elevated and brownish or blackish in color.