LEPROSY.
It cannot be stated that any known drug possesses a specific action on the malady; much can be done to stay its progress and make t lie life of the leper tolerable. In a few cases complete resolution has been known to occur, but the cure has probably been either spontaneous or has been the result of agents which have acted by increasing the natural resistance of the tissues to the bacillus in mild forms of the disease.
Preventive measures have succeeded in stamping out the disease in various localities. These should consist in rigid isolation of all lepers and the separation of children from their leprous parents; the leper should be excluded from occupations which allow of transmission of the disease, as it is decidedly contagious.
By the judicious and persistent use of certain remedial agents the disease may be retarded, and suffering may to a very considerable extent be alleviated. Good food, moderate exercise, free ventilation, and as much pure open air as the patient's surroundings will permit, may be indulged in to advantage. Agents which improve nutrition, as tonics and Cod Liver Oil, are always useful.
Of empiric agents there are two which have met with results which warrant their recommendation as valuable palliatives. Some affirm that in mild cases they are curative. These agents are Chaulmoogra Oil or its active principle—Gynocardic Acid and Gurjun Balsam. Both remedies are applied externally and taken internally at the same time. Both are as repulsive as copaiba, and as liable to upset the stomach.
Gynocardic Acid in doses of 2 grs. may be given in the form of pills after each meal, and the Chaulmoogra Oil may be administered in the form of capsules (so mins. in each), two 3 times a day, or as an emulsion or mixed with fresh cream. The dose should be gradually increased till the patient can bear no further addition, after which the maximum amount maybe persisted in as long as the patient remains able to swallow it without suffering diarrhoea or vomiting. ioo mins. daily may often be adminis tered without much gastric disarrangement. 4 drs. daily by the rectum may be employed when the stomach rebels, or it may be given hypo dermically, but the long period (several years) during which its use must be persisted in almost prohibits the hypodermic method. Rogers injects hypodermically 2-4 grs. soluble Gynocardate of Sodium, and recently he has injected into the veins gr. increased to gr. twice weekly with excellent results.
The oil should also be freely and forcibly rubbed into the affected regions alter being diluted with twice as much pure lard, or with an equal amount of lime water in an emulsion. The friction should be repeated several times a day for 15 or 3o minutes each time, and a cloth or dressing saturated with the ointment should be left in contact with the diseased surfaces.
From the beginning of the treatment the skin should never be permitted to get free from this greasy application, except for the short time during which the patient is getting cleansed from time to time by hot soda baths.
Gurjun Balsam, Wood Oil, or Dipterocarpus Balsam as it is also called, is likewise used both externally and internally, and some Indian physicians prefer it to the chaulmoogra oil. It may be given in the form of an emulsion in doses of 15 to 3o mins., or in capsules. In India a table spoonful of an emulsion made by shaking up 2 oz. of the oil with 6 oz. Lime Water is given twice a day.
Nastin, a crystallisable fat obtained from the leprosy bacillus or from Sire plothrix leproides, has been employed by Deycke hypodermically, who found that it attacked the leprosy bacillus which disintegrated, an active reaction taking place similar to that which tuberculin produces in phthisis. By combining it with a 2 per cent. solution of Benzoyl Chloride the preparation known as Nastin B is obtained, which is injected into the subcutaneous fatty tissue in doses of is mins.
Collargol intravenously and the newer Arsenical preparations hypo dermically are being tried.
Ulcerations are to be treated upon general surgical principles. Ichthyol and Resorcin Ointments (25 per cent.) are good dressings to use after applying concentrated Carbolic Acid where the ulcerated surface is limited. Iodoform gauze may be employed in some cases, but Oakum teased out carefully may make a cheap and very valuable dressing superior to all others where expense is an important object. Morris uses an ointment consisting of 3o grs. Mercury Oleate, 3o grs. Ichthyol, and zo grs. Salicylic Acid tor oz. Vaseline.
Unna regards the disease as curable, and employs warm iron-ink baths to act upon the fatty substance secreted by the bacilli; he recommends an ointment containing Salicylic Acid 2, Ichthyol 5, Pyrogallol 5, and fatty basis 88 parts, and he gives ichthyol internally, and advises excision of the tubercles and the use of Chrysophanic Acid where the skin lesions are in the early stage.
Nearly every known antiseptic and germ destroyer has been employed, and of recent years the X rays have been extolled and some cures reported after their prolonged use, and Radium emanations are also being employed with hopeful results in mild cases. Nerve stretching has been advan tageously employed for the relief of anaesthesia in non-tuberculous leprosy.
Serum therapy and vaccine treatment have given no definitely satisfac tory results. All that can be hoped at present from the use of remedies is best obtainable by strenuous use of Chaulmoogra Oil internally and locally for a period extending over several years.