Chapter VIII.
TREATMENT.
Since many cases of Leprosy terminate in cure by the disintegration and elimination of the bacilli, one might imagine that it would be a tolerably easy task to find a suitable treatment for the disease. But this is far from being the case. Treatment of Leprosy has been carried out from time immemorial. In the Bible there is little concerning any treatment which was regularly applied in Leprosy; the disease being apparently regarded as beyond human power. Later, all possible and, we may say, impossible remedies, such as the teeth of elephants, the flesh of crocodiles and serpents, the fat of panthers, lions and bears, and so on, were applied. In mediæval times, the same class of remedies was used along with religious incantations.
In the eighteenth century, Schilling tells us he treated leprosy with success. For the first three months he ordered a rather sparing diet, consisting of bread, vegetables and soup. The real treatment began with purgatives, “not mineral ones, because these are dangerous for lepers, and often produce dangerous diarrhœa,” and was followed by warm baths, “with circumspection, when the disease is far advanced, because they produce palpitation of the heart, convulsions and fainting fits.” In addition to advising frequent exercise in the open air, Schilling regarded it as important to dilute the diseased humours by large quantities of purifying fluids, of which he used first emollient decoctions, and later, powerful sudorific ones. As mild ones he used barley water, infusions of herbs, Agrimony, Hedera terrestris, Fumaria, Veronica, etc., to which were sometimes added other softening and purgative remedies, such as Malva, Parietaria, Senna and Rhubarb.
Of these the patients took, for six weeks, 3 to 4 litres daily. He then gave powerful resolvents and sudorifics, as Saponaria, Zedoaria, Sassafras, Juniper, Fol. Scolopendrii, herb. Cardui benedicti, Pareira brava, etc. The more the patient could take, the more rapid and complete, according to Schilling, was the cure. Rich food and good wine might be given. During the treatment the patient had to guard himself from cold air. After three months the patient was bled, as much blood being taken as his strength would allow. The external remedies which were used when there were putrid ulcerations, and when fingers and toes commenced to fall off, were tincture of aloes, myrrh, and succini, which were dropped on lint and applied twice a day. Both the pharmaceutical and the dietetic remedies were to be persevered with until definite signs of cure were manifest, and the treatment was to be continued for many months after apparent recovery. Many years ago this method of treatment was carried out at the Lungegaard’s hospital, but without success.
We shall next mention all the specific remedies which have been recommended and have acquired any reputation as effective.
Madar (Mudar) is one of the oldest. It is got from the Indian plant, Caloptris gigantea (Asclepias gigantea). Only the powdered bark of the root was used. Some of it was sent from India to the Lungegaard’s hospital, and was given in large doses to many lepers. The effect was absolutely nil; one might just as well have given them flour.
Dr. George Watt enumerates the following plants of which the oils have been used in India in leprosy:—(1) Albizzea Libbek, (2) Anacardium occidentale, (3) Gynometra ramiflora, (4) Dipterocarpus turbinatus, (5) Gynocardia odorata, (6) Hydnocarpus Wightoni, (7) Hydnocarpus venenata, (8) Pongania glabra, (9) Psoralea corylifolia, (10) Sunocarpus anacardium, (11) Arachis hypogæa. Of these, only a few merit more particular mention; the others have been mostly merely popular remedies.
Cashew-nut Oil, from Anacardium occidentale, Linn., Cassuvium pomiferum, Lamk, a large tree very common in the West Indies. The oil is found in the pericarp, and is extracted by ether, which, after being evaporated in open vessels, leaves a thick, brownish black oil—the Cashew-nut oil. This is the oil with which the French physician, Dr. Beauperthuy, in Cumana, Venezuela, claimed to have cured leprosy. An English physician, Dr. Bakewell, who had investigated the treatment of Dr. Beauperthuy, sent a report to both houses of parliament on the beneficial effects of the treatment, and it thus attracted much notice. Dr. Beauperthuy’s method of treatment was the following: good nourishing diet, good hygienic surroundings, frequent warm baths followed by the inunction of olive oil, and internally 1/15 to 1/20 of a grain of bichloride of mercury twice daily, or, when this was contra-indicated, 10 to 20 grs. of carbonate of soda. As external remedies, which Beauperthuy regarded as the most important, he applied different liniments, such as tincture of iodine, to which were added potash lye, olive oil, and balsam of copaiba mixed with yolk of eggs. These liniments he principally applied where herpetic or other eruptions complicated the leprosy, and to the specific eruptions he applied solutions of nitrate of silver or sulphate of copper, but especially Cashew-nut oil. In all this there is nothing new except the oil; all the other remedies have been long, and still are occasionally, used. In the Lungegaard’s hospital, the oil was tried on five patients exactly according to the directions of Dr. Beauperthuy, and after a trial of several months, the results were anything but good. The oil induced irritation, redness, swelling and vesiculation; the leprous tubers and patches remained unaltered, and in one case a leprous eruption developed, probably produced by the irritation of the oil. In Trinidad, too, the same results of the application of the oil were seen, and Dr. Beauperthuy’s treatment has been given up.
Even before Dr. Beauperthuy’s remedy had lost its reputation, a new specific remedy appeared in the East Indies, viz., Gurjun oil, introduced by Surgeon-Major Dougall, of the Andaman Islands. The oil is procured from several species of Dipterocarpus, principally D. lævis, D. tuberatus, and D. trinervus. Dr. Dougall’s method of treatment was the following: good nourishment, fresh air, and a mixture of gurjun oil and lime water internally and externally. For internal use he gave a mixture of equal parts of oil and lime water, which forms a tolerably thick emulsion, 15 grains morning and evening. Externally, he used an ointment of oil 1 part, and lime water 3 parts. With this the patients rubbed the whole body for two hours both forenoon and afternoon. The body was thus covered with a sticky layer, to which dust and dirt adhered. To remove this, the patients rubbed themselves every morning with dry earth, and afterwards took a bath in running water, before again applying the oil. The prolonged rubbing he considered not only beneficial to the skin, but useful as a gymnastic exercise. Of twenty-four lepers whom he treated in this way for six months, all, without exception, improved; all ulcerations healed without again breaking down; and, what is most remarkable, the anæsthesia almost or completely disappeared.
According to his description of the patients, some of them evidently had syphilis, some chronic eczema, and some psoriasis. Their ulcerations had been so neglected that flies laid eggs in them, and it is little wonder that they healed under the cleanliness which Dr. Dougall induced. That old anæsthesia should disappear within six months, is, to any one who knows leprosy, absolutely incredible.