Leprosy

by G. Armauer Hansen; Carl Looft

Electricity, both faradic and galvanic, has been used for anæsthetic leprosy, and electric baths, but no good effect has been attained.

Surgical measures are often needed. Section of the cornea, as introduced by Dr. Boeckmann, in the case of tubers growing into it, has already been mentioned, as has the operation of tarsoraphia interna in ectropion of the lower eyelid. Iridectomy has often to be performed, when the pupil has been obliterated by adhesions of the iris or by exudation.

Tracheotomy is necessary when the larynx is occluded by leprous-growths or by cicatrices.

Necrotomies should always be performed when there is necrosis of the bones of the hands and feet. It is astonishing how well the wounds heal in the anæsthetic parts, and patients are spared from long-standing suppuration by the removal of the necrosed bones.

The best remedy for leprosy Dr. Danielssen found in his experience to be Salicylate of soda. If the patients were badly nourished, he first administered quinine, iron, cod-liver oil, and nutritious food, and when the patient’s condition was satisfactory he gave 1.0 gramme salicylate of soda four times daily, and for six months or a year the dose was gradually increased. Its good effects were seen in both forms of the disease. In the maculo-anæsthetic form the patches and the less extensive anæsthesias slowly disappeared. In the tuberous form, when not of too long duration and severity, the rapidity of progress was diminished, and fresh eruptions were prevented. A complete cure has, however, not been attained, unless, at the same time, there have been applied regularly “cucurbita cruenta,” steam baths, alternating with warm water and sea-water baths, exercise in the fresh air, good hygienic surroundings, and good diet. From time to time irritants were applied, such as, carbolic and salicylic acids, in the form of fomentations and ointments. It is only in cases in the first six to twenty-four months that a favourable issue can be hoped for. The results of the treatment in the Lungegaard’s hospital are nothing to boast of, but they show, according to Dr. Danielssen, that leprosy at its commencement can be cured. In our opinion this is true, but with the reservation that the cure is not due to the treatment, but is the natural development of the disease. We have seen cases of leprosy, in the country, both tuberous and maculo-anæsthetic, completely recover without any treatment whatever. So far as we know, in most of the patients discharged cured from the Lungegaard’s hospital the anæsthesia has increased, which is in conformity with the general progress of the disease, the nerve fibres continuing to undergo atrophy from the pressure of the contracting inflammatory tissue in the nerve trunks, as described above.

Treatment ought theoretically to be directed to the destruction of the bacilli, and this is what Dr. Unna sought to attain by his reducing remedies, pyrogallic acid, chrysarobin, etc.; but while Dr. Unna and Dr. Deichmann succeeded in Hamburg, Dr. Danielssen had no success when using the same remedies. Dr. Danielssen believed that the bacilli were destroyed by salicylate of soda; but we fear that others will not succeed with this same remedy.

As we are then, in our opinion, unable to destroy the bacilli with remedies, either internal or external, it only remains to us to prevent infection, and that can only be attained by isolation of those affected. For this isolation no very costly measures are required. From what we saw in North America in 1888, all that is wanted is cleanliness, both personal, and in the household. But amongst the people where leprosy prevails, it is almost impossible to get sufficient cleanliness thoroughly enforced. We think, therefore, that the best measures are those which have been taken in Norway, where the lepers are isolated at their own request, and where the communities can get rid of the disease, if they will, since the sanitary authorities have the power to order the leper to live sufficiently isolated from his family, and, if he cannot or will not assent to this, can compel him to enter an asylum. At the same time, the doctrine of cleanliness and isolation and the necessity of their observance in order to prevent the spread of the disease, is constantly preached.

Since the state pays all the expenses of the lepers in the asylums, their families are generally relieved by getting rid of the lepers, who are almost invariably bad workers and unable to earn their living.

These measures are quite adequate in a democratic country like Norway, where the communities have governed themselves since 1836, and the results are most satisfactory, seeing that we had in 1856, 2833 lepers, and at the end of 1890 only about 950, which number, when corrected, will probably amount to about 1100.

Whether the same measures would be adequate in other countries where leprosy prevails, we cannot of course say; it must depend on the social condition of the community. But we are firmly convinced that isolation must be carried out in some appropriate fashion.