[238 MOTHERS' REMEDIES]
The usual vehicle by which the disease is transmitted is the secretions of a leprous patient containing bacilli or spores. The question of inheritance of leprosy is regarded now as standing in the same position as that relating to the inheritance of tuberculosis; no foetus, no new-born living child, has been known to exhibit the symptoms of either disease. Several cases have been cited where infants but a few weeks old exhibited symptoms of leprosy. It affects men more than women. Infection is more common after the second decade, though children are occasionally among its victims. When it occurs in countries where it had not previously existed, its appearance is invariably due to the infection of sound individuals by lepers first exhibiting symptoms where the disease is prevalent.
Neisser states this: "The number of lepers in any country bears an inverse ratio to the laws executed for the care and isolation of infected persons. The disease appears to spread more rapidly in damp and cold, or warm and moist, climates than in temperate countries. It is not now regarded as contagious. The leprosy of the book of Leviticus not only includes lepra, as that term is understood today, but also psoriasis, scabies and other skin affections," The leper, in the eye of the Mosaic law, was ceremoniously unclean, and capable of communicating a ceremonial uncleanness. Several of the narratives contained in the Bible bear witness to the fact that the Oriental leper was seen occasionally doing service in the courts of kings, and even in personal communication and contact with officers of high rank.
Symptoms.—Previous symptoms: Want of appetite, headache, chills, alternating with mild or severe feverish attacks, depression, nosebleed, stomach and bowel disturbances, sleeplessness. The durations of these symptoms is variable. Some patients will remember that these symptoms preceded for years the earliest outbreak of lepra (leprosy). In other cases only a few weeks elapsed. These earlier skin lesions are tubercular, macular (patches), or bullous elevations of the horny layer of the skin. It may then be divided into three varieties tuberculous, macular and anaesthetic.
LEPRA TUBEROSA. (Tuberculated, Nodulated or Tegumentary (skin) Leprosy).— This nodular type comprises from ten to fifty per cent of cases. After the occurring of the symptoms just mentioned spotted lesions appear, which are bean to tomato in size, reddish brown or bronze-hued patches, roundish, oval or irregular in contour, well defined, and they occur upon the face, trunk and extremities. The skin covering them is either smooth and shining, as if oiled, or is infiltrated, nodulated and elevated. The surface of the reddened spots is often oversensitive.
[INFECTIOUS DISEASES 239]
After a period ranging from weeks to years, tubercles rise from the spots described, varying in size from a pea to that of a nut, and they may be as large as a tomato. They are in color, yellowish, reddish-brown, or bronzed, often shining as if varnished or oiled, are covered with a soft, natural, or slightly scaling outer skin, roundish or irregular in shape and are isolated or grouped numbers of very small and ill-determined nodules may often be seen by careful examination of the skin in the vicinity of those that are developed. They may run together and cause broad infiltrations and from this surface new nodules spring. They may be in the skin or under the skin and feel soft or firm. The eruption of these tubercles is usually preceded at the onset by fever, as well as by puffy swelling of the involved region, eyelids, ears, etc. These leprous tubercles choose the face as their favored site. They mass here in great numbers, and thus produce the characteristic deformity of the countenance that has given to the disease one of its names, Leontiasis (lion face).
In such faces the tubercles arrange themselves in parallel series above the brows down to the nose, over the cheeks, lips and chin, and as a result of the infiltration and development of the conditions the brows deeply over-hang; the globes of the eyes, and the ears, are so studded with tubercular masses as to stand out from the side of the head. The trunk and extremities, including the palms of the hands and soles of the feet, are then usually involved to a less degree. The arm-pit, genital and mammary regions, and more rarely the neck and the palms of the hands and soles of the feet, may be invaded. In occasional cases when the development of tubercles upon the face and ears is extensive, there may not be more than from five to fifty upon the rest of the body, and these either widely scattered and isolated or agglomerated in a single hard, flat, elevated plaque of infiltration upon the elbow or thigh. When the tubercles run together (become confluent) large plaques of infiltration may form, which are elevated and brownish or blackish in color.
The soft palate and larynx are often involved when the skin lesions are present. The voice may sound gruff and hoarse, and the tongue, the larynx and soft palate have been found studded with small sized, ashen-hued tubercles. These tumors or tubercles may degenerate and form into irregularly outlined, sharply cut, glazed ulcers, with a bloody or sloughing floor, or they may disappear and leave behind pigmented, shrunken depressions, or they lose their shapes from partial resorption. A large plaque may flatten in the center until an annular disk is left to show its former location. Coincident symptoms are disturbance in the functions of the sweat and sebaceous secretion, thinning and loss of hair in the regions involved, especially the eyebrows, and disorders of sensibility. Later results, are a nasal catarrh, atrophy of the sexual organs in both sexes, with impairment or loss of procreative power, hopeless blindness. However the course of the disease is very slow, and years may elapse before these several changes are accomplished. Often the disease appears quiescent for months at a time, after which fever occurs and with it acute or sub-acute manifestations appear, including gland disease, orchitis, ulcerative processes, slow or rapid, followed by gangrene and a relatively rapid progress is made toward a fatal conclusion.
Toward the last the mutilations effected by the disease may result. Parts of the fingers or toes, whole fingers or toes, and entire hand or foot may become wholly or partially detached by the ulcerative and other degenerations. This stage of this type of the disease may extend through ten or more years. After it has fully developed the dejected countenance of the leper, with his leonine expression and general appearance is highly characteristic.