Lepra Anaesthetica. (Nerve Leprosy.  Atrophic Leprosy.  Lepra Trophoneurotica).—­Before the development of this form of leprosy there may be one or two years of ill-health.  Usually the skin at this time becomes in localized patches over-sensitive, sometimes there is over-sensitiveness and special nerves, because of their enlargement, become accessible to the touch.  Those named later become tender, and the seat of lancinating or shooting pains.  This clinical variety may be commingled in its symptoms with each of the other types.  With or without such commingling, however, there commonly is noted, after exposure to cold or after being subject to chills first an eruption, red (erythematous) patches, or of “bullae,” size of a bean on cheeks, ears, back of the feet, and ankles.  The eruption may be outer skin covering (epidermis) and filled with a clear tinted or blood-mixed serum, and usually occurring upon the extremities.  The scars that follow are shrunken (atrophic) patches, each often greater in extent than the base of the original trouble, color whitish, shiny, glazed, or better described as a tint suggesting the hue of mica; their outline is circular and form also the dumb-bell figure by running (coalescing) together, or juxtaposition.  These scars are always without sensitiveness (anaesthetic), and they may exist together with spotted and non-sensitive patches upon the trunk or other parts such as the face, hands, feet, ankles, thighs, but rarely on the palms and soles.  Neither those of the one class nor of the other, however, are disposed over the surface of the body in lines, bands or curves, corresponding with the distribution of the skin (cutaneous) nerves.  Sometimes the ulnar and other nerves (median, posterior tibial, peroneal, facial and radial) that are accessible to the touch are swollen, tender, insensitive or as rigid as hardened cords.  Reddish-gray swellings may be recognized by the eye along the nerve tract.  General shrinking skin symptoms follow.  The skin becomes dry and harsh; there is little or no sebaceous product and the skin of the face seems tightly drawn over the bones.  As a consequence of deforming shrinking (atrophy) of the eyelids, a persistent overflow of tears, consequent eye changes follow, and a constant flow of saliva escapes from the parted lips.  The fingers are half drawn into the palm of the hands; the nails are distorted and ulceration occurs later.  These ulcers are irregular, oval, roundish or linear in form covered with thin blackish, flattened, tenacious crusts with soft bases, and their floors covered with a soft debris mixed with blood, the whole insensitive to every foreign body, and external application.  At last the symptoms of mutilating lepra (leprosy) may occur, digits or portions of the wrist, part of hand (meta carpus) or corresponding portions of the foot may be detached from the body.  Death may occur at any time during the course of the disease.  In this form it is said to last from eighteen to twenty years and is thus not so rapidly fatal as the tubercular variety.