It is probably contagious, though that is not certain. At any rate, it is transmitted from parents to children, more frequently by the mother than the father. It usually commences in early adult life. It seems to have arisen in marshy districts on the banks of the Nile ; and it was at its worst during the Crusades of the eleventh and twelfth centuries.
Three varieties of leprosy are described. One form is spotted leprosy, in which reddish cop pery spots appear on the skin, and are met with on the mucous membrane of the mouth, throat, nostrils, and eyes. They spread at the margins, and after a time become paler at the centre, smooth, and shining. The redness may disappear and leave a bronzed stain or an un natural whiteness. This form may exist for a long time, appearing and disappearing. The reappearance is frequently preceded and ac companied by fever, a feeling of languor, dul ness of spirits, chilliness, and a general feeling of illness. The second form is a more advanced stage. The patches are no longer discolora tions of the skin, but are raised, and form tubercles, thickenings in the skin, varying in size from a small shot to a nut. They appear specially on the hands, arms, and feet, and on the face. A remarkable alteration is produced in the appearance by them. Along the eye brows the tubercles produce a frowning look. The hair of the eyebrows falls out, a thickened modulated appearance of the whole face results from tubercles over nose, cheeks, chin, and lips, so that a lion-like ruggedness is imparted to the face. Hands and feet become deformed ; abscesses and ulcers form ; fingers and toes may be lost by death of the parts. Hair dis appears from the affected patches, and nails become cracked and distorted. In the third variety patches of skin become insensible, but surrounded by over-sensitive regions of skin. Wasting of the skin sets in, and wasting of muscles and bones. The fingers are remark able for thinness. As a result of wasting, de formity and mutilation are produced. The early stage of this variety is characterized by the formation of blebs on the skin, which burst and leave behind inflamed and ulcerated sur faces. When the ulcers heal, white, smooth, depressed scars, without hair and deprived of sensitiveness, remain. The various kinds of the disease may be seen on one individual.
Leprosy is a fatal disease, though it may be slow. Death may arise from exhaustion or
affections of lungs or bowels. The tubercular form lasts on an average eight or ten years, and the form attended by loss of sensation (the anesthetic form) may last for twenty years.
Treatment consists in removing the person from the district where the disease prevails, in strict cleanliness, in attention to diet, &c. The general health is to he maintained by nourish ing food, tonics, exercise, fresh air, &c. Cod liver oil, and various other kinds of oil, have been used, and may be used, but are of little value, except as they help the general strength.
Lupus (Yoli me tangere).—The term lupus means a wolf, and has been applied to this disease because of its destructive tendency.
It consists in the formation of little groups of cells in the substance of the skin. The nodules thus produced may soften and break down, so that ulceration is produced; or the new growth may, after a time, disappear; but absorption of the tissue around occurs, and, owing to the loss of substance, depressed white scars occur. In the common form (lupus vulgaris) dull red nodules, resembling reddish transparent jelly, and of the size of a pin's head or a small shot, occur in groups or scattered in the skin. They slowly increase in size and number, sometimes forming tubercles by joining. They may re main without change for a long time, and then slowly disappear, leaving a white scar lower than the level of the rest of the skin. As the nodules disappear at one part, they appear beyond, and so a considerable extent of skin may be destroyed. They occur most frequently on the face and nose.
The nodules may ulcerate, and lead in this way to great loss of the skin and structures beneath it. As the ulcer slowly heals in the centre it spreads round the margin by forma tion of new nodules, which in turn break down. The nose is often destroyed in this way.
Another form—inflammatory (lupus erythe mutosus)—occura upon the face and head, ap pearing as a red patch on the nose, and later as red patches on each cheek. Spreading gradu ally at the margin, the patches unite and pro duce a " butterfly " appearance, their centres becoming whitish, shrunken, and flat. It has for some time been believed to be a variety of tubercular disease, the bacillus being found in the diseased skin.