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 for