Leprosy

Incidence of the Disease.

Since 1910 a new and more hope ful era in the 3,000-year-old leprosy problem has been opened up by the discovery of an improved treatment of at least the earlier stages of the disease. It still remains a great scourge, recent esti mates placing the world's lepers, including early little recognized cases, at two to three millions, the great majority being in tropical and subtropical Asia and Africa, the last having the highest num bers in proportion to population.

Leprosy is most prevalent in hot damp climates, and least in very dry areas, humidity being apparently favourable to the sur vival of the lepra bacillus and its transmission to others, usually through long and close contact, 40% of traced infections being due to living in the same house and 3o% more to sleeping in the same bed with a leper. Children and young adults are most susceptible. The disease is less infectious than tuberculosis, and many advanced crippled nerve cases lose their infectivity. One-third of the iso lated lepers in South African institutions were recently released on this account, with great reduction in expenditure. This policy is in opposition to segregation, which is only necessary in infective stages, and has resulted in the reduction of the lepers in Norway to only 5% of the numbers known in 1856, when it was introduced there. Sweden and Iceland show similar results. Under the more difficult conditions in poor tropical countries such as Hawaii and the Philippines, and in the absence of an effective treatment, the effects of segregation have not been so good and it has led to hiding of the earlier and more amenable cases, from whom infec tions may arise before they are discovered and isolated.

Treatment.

Numerous suggested remedies, including nastin, having failed to fulfil their early promise, only the old Indian drug, chaulmoogra oil, was known to have some power of retarding the progress of the disease by such doses as could be taken orally on account of its nauseating properties. But slightly better results were obtained by Victor G. Heiser in the Philippines by prolonged painful courses of intramuscular injections of the oil, which few patients would submit to. Real advance was made in 1916-17 when L. Rogers injected the soluble sodium salts of the fatty acids of chaulmoogra and other oils intramuscularly, and still better in travenously. This produced febrile and local reactions, accom

panied by extensive destruction of the lepra bacilli in the diseased tissues, with subsequent absorption and eventually complete dis appearance of the nodules and the organisms in a considerable pro portion of not very advanced cases.

Dean and Hollmann at Honolulu soon after introduced the prac tically important modification of using intramuscular injections of ethyl esters in place of the more troublesome intravenous ones of the sodium salts, enabling a larger number of cases to be treated. The result was that in the last f our recorded years the number of cases discharged as recovered by a board of medical experts has numbered 53% of the 399 admissions during the same period, and the total lepers, including advanced incurable cases among whom the mortality is high, are being reduced at a rate which will nearly solve the problem in Hawaii within about 25 years. In India Dr. Muir adopted a new substance, sodium hydrocarpate, as part of the routine treatment, and found it cheap, easy to administer and very effective. The British Empire Leprosy Relief Association distributes very large quantities of the drug and had supplied hy drocarpus seed for cultivation so that in a few years most of the British possessions affected would have their own supplies.

Further, at the great Culion leper settlement of the Philippines, of 4,00o cases in all stages recently treated 645 have already cleared up and are bacteriologically negative. Good progress is also being made in many other countries. Many early cases are now coming forward, for the first time in the age-long history of leprosy, in the early amenable stages and asking for admission to the leper institutions in order to obtain the new treatment. They consequently recover before they have reached the more infective stages, cutting short numerous foci of infection in the houses. Active research work, still further to improve the treatment, is going forward in several important centres. The disheartening old asylums for hopelessly advanced and often quite harmless uninfec tive 'lepers are giving place to agricultural colonies, much on the lines of tuberculosis sanatoria for the infective cases amenable to treatment.