The soft palate and larynx are often involved when the skin lesions are present.  The voice may sound gruff and hoarse, and the tongue, the larynx and soft palate have been found studded with small sized, ashen-hued tubercles.  These tumors or tubercles may degenerate and form into irregularly outlined, sharply cut, glazed ulcers, with a bloody or sloughing floor, or they may disappear and leave behind pigmented, shrunken depressions, or they lose their shapes from partial resorption.  A large plaque may flatten in the center until an annular disk is left to show its former location.  Coincident symptoms are disturbance in the functions of the sweat and sebaceous secretion, thinning and loss of hair in the regions involved, especially the eyebrows, and disorders of sensibility.  Later results, are a nasal catarrh, atrophy of the sexual organs in both sexes, with impairment or loss of procreative power, hopeless blindness.  However the course of the disease is very slow, and years may elapse before these several changes are accomplished.  Often the disease appears quiescent for months at a time, after which fever occurs and with it acute or sub-acute manifestations appear, including gland disease, orchitis, ulcerative processes, slow or rapid, followed by gangrene and a relatively rapid progress is made toward a fatal conclusion.

Toward the last the mutilations effected by the disease may result.  Parts of the fingers or toes, whole fingers or toes, and entire hand or foot may become wholly or partially detached by the ulcerative and other degenerations.  This stage of this type of the disease may extend through ten or more years.  After it has fully developed the dejected countenance of the leper, with his leonine expression and general appearance is highly characteristic.

[240 Mothers’ remedies]

Lepra Maculosa.—­This form is more common in tropical countries and is distinguished chiefly by its macular (spotty) lesions.  In size they vary from a small coin to areas as large as a platter.  They are diffused or circumscribed, roundish or shaped irregularly, yellowish, brownish or bronzed in color, often shiny or glazed.  They may be infiltrated and may be elevated, or on a level with the adjacent tissues.  The patches are usually at first very sensitive, but they finally become insensitive, so that a knife can be thrust deeply into them without being felt.  The regions chiefly affected by this type are the back, exposed parts, the backs of the hands and wrists, the forehead, the cheeks, ears, back of the feet, and ankles.  The eruptions may be scanty or general; conspicuous or insignificant.  The eruptive symptoms are associated commonly, early or late, with the serious phenomena described below.