Arch Intern Med (Chic). 1910;VI(2):147-169. doi:10.1001/archinte.1910.00050300028003.
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It is well recognized that in leprosy, especially its anesthetic form, marked deformities of the hands and feet may develop. Such cases are generally designated as "lepra mutilans." Many, perhaps the majority of these cases, are dependent on ulceration, necrosis, and chronic suppurative inflammation, which in turn are indirectly due to a chronic leprous neuritis with its accompanying anesthesia and analgesia. Necroses or ulcers form, phalanges gradually slough off, and finally the characteristic, clubbed hands and feet of leprosy are formed. The accompanying illustrations of such hands and feet show their appearance in some very pronounced cases. This explanation does not hold in all cases, however, as some of these deformities are to be ascribed to a peculiar trophoneurotic influence which is probably directly exerted by the neuritis on the tissues, especially those of the osseous system, and which may result in atrophy of bone of characteristic


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