Leprosy

Leprosy is a disease that has been known from the earliest ages, and has prevailed among all races and in all climes.

At present it is most widespread in countries lying both to the north and to the south of the temperate zone and among the less enlightened people of the earth. To a limited extent, however, it is met with in Europe and the United States.

The disease manifests itself in three chief forms or phases of development, known as the macular, tubercular, anaesthetic. The first is characterized by the development of brownish discolorations of varying size and number. These, after an existence of months or years, may lose their height­ened color and become pigmentless, and the cutaneous nerves in the affected parts lose their sensibility.

The tubercular form is characterized by the development of tubercles upon various parts of the body. These exhibit a slightly heightened color, becoming later some­what copper-colored, ana affect a preference for the face, especially just above the eyebrows and upon the nose and ears, but may, and usually do, appear upon the extremities.


In the anaesthetic form, bullae, usually solitary, develop upon various parts of the integument. They persist for a short time only and leave behind them discolorations, which in time may become whitened and anaesthetic. In this form of the disease there is grave implication of the principal nerve-trunks of the extremities. This is notably the case with the ulnar nerve, which, in cases moderately advanced, may be readily perceived as a thickened cord just above the head of the bone whose name it bears. In this form, especially, pain in the extremities is a more or less prominent feature. Connected with the development of the disease, anaesthesia of the integument, chiefly of the extremities, becomes a prominent feature. The gradual destruction of the ulnar nerve leads to impairment of its functions and atrophy of the more distant parts to which it is distributed. This atrophic action is most distinctly manifested in the fingers and toes. Fissures occur in the integument and absorption of the phalanges takes place and leads to loss of these parts. The separation usually occurs at some point between the joints rather than at the joints themselves. A continuance of the morbid action may result in loss of all the phalanges, and even of some of the metacarpal and metatarsal bones. Leprosy is essentially a chronic disease. Before the appearance of cutaneous or nervous lesions there usually exists a prodromal period of several years' duration, without definite symptoms other than impairment of the gene­ral vigor. During this period it is hardly possible to make a diagnosis of the impending trouble. After the disease, however, is fully developed, ten, fifteen, or twenty years may pass before the fatal termination.


After careful investigation Drs. Fost and Graham arrive at the following conclusions concerning leprosy:

1. Leprosy is a constitutional disease, and, in certain cases, appears to be hereditary.
2. It is undoubtedly contagious by inoculation.
3. There is no reason for believing that it is transmitted in any other way.
4. Under certain conditions a person may have leprosy and run no risk of transmitting the disease.
5. It is not so liable to be transmitted to others as is syphilis in its early stages. There is no relation between the two diseases.
6. Leprosy is usually a fatal disease - its average duration being from ten to fifteen years.
7. In rare instances there is a tendency to recover after the disease has existed many years.
8. There is no valid reason for pronouncing the disease incurable.
9. Judicious  treatment improves the condition of the patient and often causes a temporary disappearance of the symptoms.
10. There is a ground for the hope that an improved method of treatment will in time effect the cure of leprosy, or at least that it will arrest and control the disease.

Dr. Perry has arrived at the following conclusions, after years of study and residence in India:

1. Leprosy is an endemic disease, malignant, constitutional, progressive; evidenced by tubercular degeneration of the tissues, and accompanied by anaesthesia, ulceration, and gangrene; terminates in death from exhaustion, pyae­mia, or rupture of the arteries.
2. That it is due to a specific bacillus he considers an unsettled point.
3. That leprosy is contagious only by inoculation, the direct transmission of the virus into the blood of healthy persons. This assertion does not exclude the transmission of the disease by clothing, tools, etc., which have been used by lepers.
4. The disease is practically limited to people living upon a fish diet along the sea coast.
5. It is incurable. The best treatment is only palliative. His experience with iodide of potash, iodoform, mercury, and other so-called antisyphilitics having been as satisfactory as with chaulmoogra oil and other rarer and costlier drugs.
6. The average life of the leper, after the full development of the disease, is from ten to fifteen years. This does not include the  prodromal stage. Some cases die sooner, and some live much longer.
7. The period of incubation is less than one year; the prodromal stage may last for five or more years. Leontiasis may develop in twelve months, and may be the only hint of the latent diseases for years, until some exciting cause brings it out.
8. Hereditary leprosy does not usually develop until the age of puberty, unless there be some exciting cause. This exciting cause may be inflammatory skin disease, suppurating wound, or prolonged illness.