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.

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 disord