For hypodermic use Heiser makes a mixture of 60 cc. each of chaulmoogra oil and camphorated oil with 4 grams resorcin. Injections are made weekly, commencing with 1 cc. This dose is increased steadily according to tolerance, but in some patients marked reaction in the lesions, with fever, occurs after a dose of only a few cubic centimeters has been reached.
Rogers has for some time been giving subcutaneous injections of sodium gynocardate, the sodium salt of the lower melting-point fatty acids of chaulmoogra oil. Finding that large doses of sodium gynocardate could be administered to animals with safety he has recently given intravenous injections and has substituted this method for the subcutaneous one. For use in the treatment of leprosy he prepares a 2 or 3% solution in distilled water and, after sterilization in an autoclave, adds ½ per cent. carbolic acid. The solution should be quite clear. He starts with one-tenth of a grain and increases the dosage by one-tenth with each successive injection up to four-fifths of a grain. He states that this method has as great superiority over the subcutaneous one as that has over the administration of chaulmoogra oil by mouth. Rogers now uses a solution of 3% sod. gynocardate with 1% phenol and 1% sod. citrate. At first the intravenous injection is with 0.5 cc. thrice weekly, which dose is gradually increased up to as much as 5 cc.
It is possible that sodium morrhuate (cod-liver oil) may be as efficacious as the gynocardate salt. Rogers has used Hydnocarpus instead of the true chaulmoogra oil and thought he obtained better results. One explanation of the uncertainty of success with chaulmoogra oil is the difficulty of securing oil obtained from proper sources. The standard treatment of leprosy in Honolulu, as reported by McDonald, is the weekly injection of the ethyl esters of the entire fatty acids of the whole chaulmoogra oil, with 2% by weight of iodine, chemically combined. The treatment begins with 1 cc. injected intramuscularly, increased by 1 cc. at every second or third injection, until a dose of from 2 to 6 cc. is reached, according to age and weight of patient.
For internal use the mixed fatty acids, carrying 2½% iodine, chemically combined, are given in capsule. The dose by mouth is 0.25 grams per 100 lbs. weight, three times daily, an hour or two after meals. This is gradually increased every two weeks until a maximum dose of 1 gm. per 100 lbs. weight is reached.
Dyer combines hydrotherapy with the administration of chaulmoogra oil. He gives a daily bath as hot as can be borne, and, in addition to the specific treatment, gives 1/60th grain of strychnine three times daily.
Antileprol, a preparation of chaulmoogra oil, which is more satisfactory than oil, may be given in doses approximating 120 grains by mouth daily or 60 grains subcutaneously. Such drugs as arsenic salicylate of soda and bichloride of mercury have been used.
Thyroid extract has seemed to benefit cases of anaesthetic leprosy in rare instances. The high frequency current with the needle applied to the nodular lesions has been recommended by Unna. Radium and X-rays have also been employed. There have been reports as to the value of the antimony treatment in leprosy.
Leprosy is a disease in which improvement often occurs when the patient is placed under more favorable conditions as to food, climate, etc. Again, there is at times a tendency for the disease to abort or ameliorate without relation to treatment or environment.
Surgical treatment is frequently of use, as nerve stretching for the leprous neuralgias. Various eye operations are necessitated by the ectropion or leprotic iritis. The amputations of the area involved in perforating ulcer is recommended. Tracheotomy is often demanded for the laryngeal stenosis.