The diagnosis of anesthetic leprosy is often very difficult, as the bacillus of Hansen is obtained in only a small proportion of the early cases and consequently the diagnosis usually rests on the symptoms and signs of the neuritis and the gross trophic changes arising from it. These trophoneurotic changes are usually most marked in the extremities and may affect any or all of the tissues of the extremity.
The changes which take place in the nerves, muscles, subcutaneous tissue and skin have been emphasized by the writers on this disease and are well known to all. But the corresponding changes occurring in the bone, although of equal if not of greater diagnostic significance, have been simply mentioned in the descriptions of this disease. This is readily understood when we consider the difficulty of determining these changes early in the disease, before it has advanced to such a stage that