Nervous System.—Besides the characteristic anaesthesia we have various manifestations of neuritis, especially involving the ulnar, facial and peroneal nerves. The affected nerves show a fusiform enlargement and are tender. Later we have trophic changes in skin, bone and nails of the fingers and toes. Absorption of bones and perforating ulcers are common. Muscle palsies and atrophies, especially the main-en-griffe, are common. The orbicularis palpebrarum is not infrequently paralyzed. The olfactory, optic and auditory nerves are rarely if ever involved. The reflexes are slightly exaggerated.
Patients often complain of a sensation of cold. Some authorities have called attention to the frequency of a mental and moral apathy in lepers.
The Circulatory System.—Honeij considers a high pulse rate, especially in the morning, as characteristic of progressive stages of leprosy.
The Eye.—In nodular leprosy eye lesions, chiefly leprotic nodules in conjunctivae or iris, with subsequent ulceration, are met with at some time in the course of the disease in almost 90% of cases. In nerve leprosy, corneal ulcerations, chiefly resulting from paralyses of the facial muscles, with ectropion, give eye symptoms in about 45% of cases.
Genito-urinary Symptoms.—Atrophy of the testicles with increase of connective tissue often result in males but data would indicate that the procreative power of the female is but little diminished. Lepers often die of renal complications, the kidney lesions being rather those of amyloid change. Bacilli may be eliminated in the urine during accessions of fever.
The Lymphatic Glands.—These tend to enlarge and show bacilli, but rarely suppurate.
The inguinal and cervical glands are most often enlarged.
The Blood.—The changes, other than those of a secondary anaemia as the disease progresses, are not characteristic. Bacilli are present in the blood of cases of nodular leprosy quite constantly but less so in that of cases of nerve leprosy. The bacilli are more apt to be found in the blood at the time of febrile accessions.