-M.L.TYLER
DEFINITION.- A chronic infectious disease, caused by a specific bacillus, characterised by tubercular nodules in the skin and mucous membranes, or by changes in the nerves. The forms may be separate at first, but are combined in the course of time.
The disease is a very ancient one, and has been known for thousands of years, although various skin diseases were no doubt confounded with it sometimes. It was once widely spread over Europe, but has declined since the sixteenth century. To-day it is found in Iceland, Norway, Sweden, Russia and parts of Spain. There are a few small foci of the disease in Canada and U.S.A. It occurs in the West Indies and Mexico, and the Sandwich Islands, and in South Africa, Australia and New Zealand. It is wide-spread in China and India.
The cause of the disease is a bacillus which has certain resemblances to the tubercle bacillus. It is very difficult to cultivate, but genuine cultures appear to have been made. The bacilli are found in the open sores, and in the secretions of nose and throat, and probably enter the body through mucous membranes or skin. Probably infected clothes play a large part in spreading it, and in any tropical country the laundry arrangements need the most careful supervision.
SYMPTOMS.-In Tubercular Leprosy the first symptom is that of areas (maculae) of erythema in the skin, which are highly sensitive. Pigment often develops in them and on these places the characteristic tubercules develop. They may grow into nodules of some size with intervening areas of ulceration and partial cicatrization. Deep ulcers may form, leading to loss of fingers or toes. Sometimes tubercules do not develop, but the maculae become insensitive and lose all pigment, so that the skin there becomes perfectly white. Eyelashes and eyebrows fall out in later stages, the mucous membranes of nose, throat and often conjunctiva become inflamed, and death often results from pneumonia or laryngeal inflammation, In Anaesthetic Leprosy the first symptoms are usually pains in the limbs and areas of numbness, Maculae or bullae (large blisters) may form and leave areas of anaesthesia when they disappear. The nerve trunks where they are palpable are found to be large and nodular. Later large bullae develop; they break and leave destructive ulcers, with
loss of substances. This form is very chronic.
TREATMENT.-Since the bacillus (or more properly speaking, streptothrix, for it probably not a true bacillus) has been cultivated, it is possible to make a vaccine and encouraging results are reported from its use (Rost). Chaulmoogra oil has a certain reputation with orthodox physicians.
HOMOEOPATHIC TREATMENT.- Apart from vaccines (which are in principle homoeopathic), homoeopathic treatment holds out some hopes of relief or cure, but homoeopathy has not had much opportunity to try its methods hitherto. The following should be useful remedies:-
Sulphur.-(Occasional doses of high potencies) will almost certainly be needed as an intercurrent remedy in the course of this disease.
Sepia is more likely to be needed in later stages when ulceration and tubercles are well developed.
Silicea.-Later stages, with ulceration.
Anacardium.-Anaesthetic patches with weakness and prostration.
Arsenicum.-Hyperaesthesia and anaesthesia; involvement of nerve trunks.
Comocladia.-Skin white.
Lachesis.-Deep ulcerations.
Phosphorus and Graphites are other drugs that should be borne in mind, and Hydrocotyle has been much praised.
All discharges from wounds and mucous surfaces should be carefully disinfected and great care exercised by any who come in contact with the cases to avoid contagion. Lepers, wherever possible, are isolated in definite communities.