Treatment.—H, as is ROW believed by Morrow, Hansen, Sticker, and others, "the vehicles of the virus through which contagion is affected in the vast majority of cases are the secretions of the mouth and nose," while "the port of entrance is the mucous membrane of the respiratory and intestinal tract with secondary in fection through the blood or lymphatic system" (Morrow), attention to the nasal cavities, the mouth, and throat is of primary importance.
Attention dralln to the importance of the nasal treatment, not only on account of the patient himself, but also in order to prevent the spread of the disease. Sticker (Munch. med. Woch., Nos. 39 and 40, '97).
The normal secretions of the nasal cavities are alkaline and of a higher spe cific gravity than water; hence, the use of the latter as detergent is painful and irritating to the mucous membrane. Any liquid used for this purpose should at least possess the alkalinity and specific gravity represented by 1 drachm of com mon salt to 1 pint of water. As a wash, the following mixture can be confidently recommended after extensive trial in dis orders of the upper res.piratory tract:— 4 Borate of sodium, Bicarbonate of sodium, of each, V, rachm.
Fluid extract of Canadian pine, 1 drachm.
Glycerin, 2 drachms. Water, 1 pint.—M.
This may be used with an atomizer producing a coarse spray night and morning, the cavities being thoroughly drenched. In large colonies under mu nicipal management borax and bicarbo nate of sodium, equal parts, may be pro cured in bulk and dealt out to patients with instructions to use 1 teaspoonful of the powder to a pint of lukewarm water. An economical way is to inhale the solu tion from the band, using the latter as scoop. When ulceration is present, the local treatment for syphilitic rhinitis (q. v.) is indicated. The secretions, as already stated, should be destroyed, and the use of spit-cups rigidly enforced.
Segregation where lepers have pre viously lived without resorting to such precautions should be avoided.
Cleanliness of the surface should be carried to its maximum possibility com patible with the patient's strength. As a curative measure, Baelz, of Tokio, rec ommended 3 to 5 strong mineral baths at 45° to 53° C. a day for a period of about one month. His results were ex cellent. Sea-bathing was extensively used, and with marked advantage, dur ing the early part of the century. At
first warm sea-water baths were given, until all "scaly incrustations" were re moved; after this "a cure was soon ob tained, especially in young persons, by bathing in the open sea" (Willan).
Among the internal remedies recom mended by dermatologists, chaulmugra oil (see description in volume ii) may be said to hold the first place. The re sults obtained from its use have been varied, but, assisted by the prophylactic measures outlined above, its usefulness will probably be vastly increased. It has been administered in doses of from 10 to 200 drops. By beginning with small doses and gradually increasing the quan tity given, the gastric disorders occa sionally following its use may generally be avoided or at least retarded until active benefit is procured. It is borne morts easily by lepers. than by healthy subjects, and its use can be continued years. if need be. Many ,-..ases have been r, ported in which permanent cure had been obtained.
Tonics may be given at the sarne time. These agents, especially arsenic and strychnia. are of practical iinportance by tending to overcome the general ady narnia.
Experiments upon 1,24 patients as to value of chaulinvi:rra-oil show increase of perspiration. decrease of tubercles. im proved appetite and 7,,e11se 0f well-being, increase of sensation and inereased sup pleness of skin. and lessening of pains in the joints. 'Elle oil was not administered in cap-riles, but drunk pure. The dose used was '/, to 1 drachm daily. Creolin used with excellent results, a.s a pallia tive and tropical remedy. Benven Rake i"Annual Report 011 Leprosy and the Trinidad Leper Asylum.- '90).
Lepers treated Nvith large doses of chaulimigra-oil, either by intramuscular injections or by the mouth. may show so intich improvement as to be consid ered cured. Alore frequently the disease continues to show itself. but usually in a beni:rn manner. In some eases marked local and general exacerbations occur in -pite of the treatment. The effect of the eliatilmugra-oil. although beneficial, cannot be eompared with that of mer cury and iodine in syphilis or of quinine in malaria. The hypodermic method is to be preferred if it i.s well. borne; it is, however. a painful method. Hallopeau (-Lcpra," vol. ii, 2, 1901).