Leprosy

“ A very remarkable feature in connection with leprosy is the hysterical dread that many communities have of a leper, when they must know or could easily learn, that the contagiousness of the affection is so slight, that notwithstanding our efforts, we can scarcely point to a single instance to prove undoubted transmission of the disease from one person to another. At any rate knowing that immense numbers of the bacilli are given off from ulcerations and the nose, we should guard against the dissemination of leprosy bacilli from such sources. ”

“ Nodular leprosy is usually a much more acute disease than nerve leprosy, sapping the strength and general health much more effectually and more quickly. It rarely runs its full course, death being brought about by some intercurrent disease, such as, and especially, phthisis, nephritis, albuminoid degeneration of the alimentary tract, dysentery, stenosis of the larynx, or pneumonia. ”

“ The chronicler has nothing farther to say as to the cause of the leprosy, than the opinion of “a certain philosopher,” that whatever turns us from health to the vices of disease acts by the weight of too much blood, by superfluous heat, by humours exuding in excess, or by the spirits flowing with unwonted laxity through silent passages. ”

“ One is very apt to be deceived in estimating the value of a drug in leprosy. The leper applies for treatment generally during, or soon after, one of the periodical exacerbations of the disease, and when the nodules and other eruptions are active and well pronounced In the natural course of events, and without treatment of any description, especially if the patient be placed under favourable hygienic conditions, these acute manifestations tend to become quiescent, and the disease temporarily to ameliorate. ”

“ Here is vileness indeed, a very type of impurity; and here we see how sin looks in the eyes of God.
His limbs swollen, his hair white, tumours appear on his jaws, his breath noisome, and his whole person fitted to inspire loathing.
Leprosy is infectious and of slow progress. It begins within the body, and throws out a moisture which corrupts the outside, and covers it with a kind of white scale. It is said that the body becomes so hot that a fresh apple held but an hour in the hand will be withered and wrinkled. The parts of the body infected become insensible, and in time fall off. ”

“ What evidence we have at our disposal, however, is all in favour of the transmissibility of the disease from patient to patient and through the agency of the leprosy bacillus. None of the numerous non-bacillary theories of leprosy account at all satisfactorily for this transmissibility of the disease, for its progressive nature, and for the peculiar series of histological changes that are met with in various parts and organs of the leprous body. Leprosy occurs in all climates. ”

“ It would be a not uninteresting task—though a somewhat laborious one, as the notices of this disease are, for the most part, of a scattered and fragmentary description—to trace the gradual decline of leprosy in Europe. The great cause of its disappearance is undoubtedly the vast progress that has been made in sanitary matters. Our Europe is not the Europe of three centuries ago. The uncultivated and marshy era is past, with its humid and miasmatous atmosphere, its squalid and unwholesome dwellings. Those cachectic days are gone by for ever, and the leprosy is gone by with them. ”

“ How great, how incurable and contagious, a disease was leprosy is plain from hence, that lepers, both by the ancient law and the usage of all nations, were debarred from consorting with their fellow men. For in lepers there is a contagion which spreads by contact with the whole, whom they are able to infect by the stench of their ulcers and their fetid breath. ”

“ With them, by the contagion and the infection of the disease, the face is disfigured, the hair falls off, the nostrils are enlarged, the bones are eaten away, and the tongue swells, in short, every kind of disease, and all their symptoms, are found as the accompaniment of leprosy. Physicians teach that it may be considered an elephantine disease, and incurable. How, says Avicenna, can leprosy be cured, since it is an universal cancer, when even a single cancer is beyond the power of medicine? ”

“ I wish particularly to point a moral in ‘Old Ninety-Nine’s’ case, as the symptoms there manifested will be among the most difficult to treat, particularly in the uneducated. First, because the word leprosy is crystalized in the human mind into an incurable disease and having once had it, a patient, unless of unusual intellect, lives in constant dread of its return—our hospitals for the insane would grow beautifully less by the elimination of that one element fear. Leprosy is a germ disease; the leper bacillus was discovered in 1874. ”

“ Leprosy is very rarely congenital, and no cases have occurred among the descendants to the third generation of 160 Norwegian lepers settled in the United States. Again, if hereditary transmission were an effective influence, the disease could hardly have died down so rapidly as it did in Europe in the 15th century. Then we have the theory of contagion. There is no doubt that human beings are inoculable with leprosy, and that the disease may be communicated by close contact. ”

“ The history of the spread of leprosy is peculiar in that those who live with lepers in institutions and are constantly in contact with them do not as a general thing contract the disease. I refer to such people as doctors, nurses and attendants. On the other hand, people who have never known of any contact with a leper sometimes develop the disease. ”

“ He shall not isolate him, for he is unclean.
13:12 "If the leprosy breaks out all over the skin, and the leprosy covers all the skin of the infected person from his head even to his feet, as far as it appears to the priest; 13:13 then the priest shall examine him; and, behold, if the leprosy has covered all his flesh, he shall pronounce him clean of the plague. It has all turned white: he is clean. 13:14 But whenever raw flesh appears in him, he shall be unclean. 13:15 The priest shall examine the raw flesh, and pronounce him unclean: the raw flesh is unclean. It is leprosy. ”

“ Thornton, of the Leper Hospital of Madras, said:—That his experience showed him [31] that Leprosy was contagious, and that it was likely to spread to this country; that the disease, however, could rarely, if ever, be communicated, except in the case of a healthy person by an abraded skin, coming in contact with a Leper. “The sufferings of the afflicted can be alleviated by (1) a liberal diet; (2) oleaginous anointings, by which the loss of sleep, one of the most distressing symptoms of the disease, can be prevented.” ”

“ The guide said there were two kinds of leprosy, the 'wet' and the 'dry.' In the wet leprosy the body of the victim abounds in running sores, while in the dry there is nothing of the sort, and the appearance of the skin is not greatly different from what it is in health. The disease generally attacks the joints of the hands or feet, particularly those of the former, and the sufferer loses the first joint of the fingers and thumbs at about the same time. ”

“ She breeds plagues and pestilences and looses death to hold its carnival. Leprosy distorts the countenances of hundreds of thousands of men and women, renders loathsome their touch, and encrusts their bodies with plague spots of disease more horrible than death. ”

“ At such times sweating may be present and suggest malaria. In the final stages of leprosy the patient may run a high fever for long periods, associated with profuse sweating and loss of weight.
Skin.—The raised spots of nodular leprosy tend to come out in numbers on lobes of ears, over eyebrows and on cheeks, as well as backs of hands and forearms and on buttocks and feet. Soles of feet and palms of hands almost never show spots. ”

“ The disease runs a very chronic course, and may last twenty or thirty years. Recovery occasionally occurs. In the mixed form, which is probably the most common, the symptoms described are combined in varying degrees. Leprosy may be mistaken for syphilis, tuberculosis, ainhum (an obscure disease affecting negroes, in which the little toe drops off) , and several affections of the skin. Diagnosis is established by the presence of the bacillus leprae in the nodules or bullae, and by the signs of nerve degeneration exhibited in the anaesthetic patches of skin and the thickened nerve trunks. ”

“ Armauer Hansen discovered the bacillus leprae in 1871, but no one has gotten much further than that. Its only alleviation is surgery, but this is sometimes without avail. Leprosy is of three well-defined kinds: There is Running Leprosy, the most horrible of the three. It shows itself mainly as shiny ulcers, which throw off a highly offensive perspiration. In this kind, the fingers, ears, nose, and eyes are often eaten away, leaving a hideous bundle of flesh that but faintly resembles a human being. Dry Leprosy, the second variety, does not take such an offensive form. ”

“ LEPROSY (Lepra Arabum, Elephantiasis Graecorum, Aussatz, Spedalskhed) , the greatest disease of medieval Christendom, identified, on the one hand, with a disease endemic from the earliest historical times (1500 B.C.) in the delta and valley of the Nile, and, on the other hand, with a disease now common in Asia, Africa, South America, the West Indies, and certain isolated localities of Europe. An authentic representation of the leprosy of the middle ages exists in a picture at Munich by Holbein, painted at Augsburg in 1516 ”

“ Do not the botches, blains and spots (called God’s tokens) accompanied with raving and death, argue a stranger [sic] infection than that of the leprosy, to be judged by botches and spots? [the infectiousness of leprosy being proved by revelation, Lev. xiii.] . Doth not the ordinary experience of laying live pigeons to plague-sores and taking them presently dead away, and that one after another, demonstrate mortal infection? ”

“ To the experienced physician diagnosis in the early stages is a matter of routine, and the modern method is simple. Today, if I were forced to choose, I would rather have leprosy in an early stage than tuberculosis. But the world was slow in taking up preventive work. Isolation and treatment were everything until recently when the American Leper Association began to study the mode of leprosy’s transmission. They could only find a few old men who knew anything about the disease, so the Association had to train young investigators to look into the causes. ”

“ Some thirteen years ago, the Leprosy broke amongst the inhabitants, and some of their numbers died of it. There are two families at present labouring under the disease. The symptoms of it are, their feet begin to fail; their appetite declining; their faces becoming too red, and breaking out in pimples; a hoarseness, and their hair falling off from their heads ”

“ As a rule, leprosy is a disease of very slow development. Sometimes, it is true, it is suddenly and frankly declared from the outset, and progresses rapidly; but in the vast majority of cases the early lesions are trifling and are apt to be misinterpreted and overlooked, and years elapse before serious mutilation or deformity is produced. The student must bear this important practical fact in mind in the study and diagnosis of all equivocal skin lesions in persons residing in or coming from the endemic haunts of leprosy. ”

“ Some of the facts noted, such as the extensive dissemination of the disease in Europe during the middle ages, and its subsequent rapid decline, suggest the existence of some unknown epidemic factor. Poverty and insanitation are said to go with the prevalence of leprosy, but they go with every malady, and there is nothing to show that they have any special influence. Vaccination has been blamed for spreading it, and a few cases of communication by arm-to-arm inoculation are recorded. ”

“ 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.
Diagnosis
Clinical Diagnosis.—It must be remembered that leprosy is very slow in development, so that for months or even years there may be but slight indications of the disease, as an anaesthetic spot or the palsy of an orbicularis palpebrarum. One should always run over the lobes of the ears or region of the eyebrows to feel for shot-like nodules. ”

“ Leprosy is indirectly influenced by insanitary surroundings, such as poverty, bad food, or deficient drainage or ventilation, for these by causing a predisposition increase the susceptibility of the individual to the disease. ”

“ As the disease progresses the nodules tend to break down and ulcerate, leaving open sores. The patient, whose condition is extremely wretched, gradually becomes weaker, and eventually succumbs to exhaustion or is carried off by some intercurrent disease, usually inflammation of the kidneys or tuberculosis. A severe case may end fatally in two years, but, as a rule, when patients are well cared for the illness lasts several years. There is often temporary improvement, but complete recovery from this form of leprosy rarely or never occurs. ”

“ The sight is often dimmed or lost, and a kind of horny substance grows over the eyeballs. The skin of the face becomes thickened, giving the countenance a peculiarly heavy, morose expression. Thus the disease progresses, and the constitution becomes enfeebled, until the leper falls a victim to some other malady; for leprosy is not often the immediate cause of death. In the anæsthetic form of leprosy all feeling leaves the part specially affected. ”