(Leprosy; Elephantiasis Graecorum; Satyriasis; Leontiasis)
Definition – A chronic, insidious, endemic, contagious disease due to a specific bacillus and characterized by erythema, anesthesia, pigmentation, neoplastic growths, atrophies, ulcerations and deformities varying with the parts affected.
Leprosy, the oldest of known diseases, is at the present distributed over a quarter of the habitable globe. It is common in India, China, Japan, the Philippine Islands and parts of Africa; comparatively frequent in Iceland, parts of Canada, the West Indies, Central and South America and the Hawaiian Islands. in Europe it is chiefly found in Norway, Russia, Greece, Spain and Portugal. Sporadic cases are always present in the United States especially in our large seaport cities, but it is more constantly found in California among the Asiatics, in Louisiana among West Indians and in the northwestern states like Minnesota and Wisconsin among persons of Scandinavian origin. It is difficult to say how many cases there are within the bounds of the United States proper but probably five hundred would be an approximate figure. Nearly all of these cases have contracted the disease in some other country although the actual development may have taken place years after their arrival here. For the past ten years I have had from five to ten cases under my observation yearly and their clinical histories verify the preceding assertion.
Symptoms – While the manifestations of leprosy vary widely, it is convenient to describe three principal forms (1) the nodular or tubercular, chiefly involving the skin and mucous membranes; (2) the anesthetic, chiefly attacking the peripheral nerves; (3) the mixed form including both of the other two types. The stages of the disease are not well defined but periods of incubation, of invasion and of eruptive and degenerative changes may be recognized.
The length of the stage of incubation is uncertain and difficult to exactly establish as there are no recognizable initial lesions in a vast majority of cases because it is probably that inoculation does not usually occur through the skin. A person coming from a leprous to a non-leprous country without any signs of the disease, who develops prodromal or eruptive symptoms after an interval. This indefinite interval may vary from a few weeks to years, even running as high as ten, twenty or forty years. If a patient resides some years in a leprous country, it is manifestly impossible to fix the date of the beginning of an incubation ending years later. The wide difference in the induration of the incubating period no doubt is due to personal idiosyncrasy as modified by food, habits, climate, etc., but it is interesting to note that most of the cases of prolonged incubation have been in those who removed from an endemic region to one in which the disease was not prevalent.
The period of invasion, showing prodromal symptoms, follows the stage of incubation and averages several months to a year. During this period cases of tubercular leprosy will show intermittent febrile disturbances, together with modification of the sensory or motor functions, drowsiness, depression and general weakness. Hemorrhages, general or local disorders of the sweat functions, headaches, vertigo and other less suggestive phenomena are noted. Neurotic prodromata are especially common in the anesthetic form but even here they vary greatly in character and intensity. They may be so mild as to escape notice or they may take the form of more or less severe but in constant and shifting, itching, formication, tingling, smarting, burning, stiffness, numbness and pain.
Fig. 195 – Leprosy of the nodular or tubercular type, in a West Indian Woman.
The eruptive stage of nodular or tubercular leprosy first shows as a few or many, large or small spots resembling ordinary erythema. The color is yellowish-brown or reddish but disappears on pressure. the patches may be limited to one region or distributed over the body and may spontaneously disappear and reappear. The affected skin feels slightly swollen and tense, is somewhat hyperesthetic and produces a quantity of sweat. Febrile symptoms, disappear upon the full development of the macular eruption which finally fades away, often leaving no trace behind. However, some of the spots fail to resolve, become more pigmented, sharply marked and are the seat of the first true infiltration. These nodules are split-pea in size and shape, of the same color as the macules and may remain stationary or progressively enlarge. The increased deposit is often preceded by fever and the new tubercles appear in crops.
Fig. 196 – Leprosy of the tubercular variety in a native of the West Indies.
The favorit locations of the eruption are the face especially the inner angle of the eyebrows, ears, nose, chin, cheeks and lips, although they are not uncommon upon the backs, the forearms and hands. The skin affected becomes thickened and elevated into round or flat, sharply outlined prominences which, though close together, are plainly distinct from each other. Later, coalescence of these lesions will present large soft, red, yellowish or brownish-red elevations and make the surface involved present a hideous appearance. This deformity is most marked on the face, producing the so-called “leonine” expression. While these infiltrations occasionally undergo absorption, leaving stains or scars to be succeeded by fresh crops in the same or other regions, it is common for them to progress in size and extent, becoming darker in color, for three or four years before ulceration ensues. Sometimes small hard masses may persist indefinitely or take on a keloidal form. Ulcerations of leprous growths are not uncommon, forming a shallow indolent ulcer which may or may not increase in size, be superficial or deep enough to destroy even tendons and bones. Lymph structures may be involved and even suppurate.
Mucous membranes may become affected early or late in the disease. Some authorities hold that leprosy first manifests itself in these regions while others hold with Impey that these parts are usually affected about four years after the advent of the tubercles in the skin and that they are attacked in the order nearest the surface going inward, viz., the lips, tongue, palate, fauces and larynx. Leprous ulcerations of these structures are both painful and persistent and cause a discharge that produces a characteristic sweetish odor.
Fig. 197 – Leprosy of the mixed variety with pronounced tubercular infiltrations on the face. Patient, a Greek of thirty years of age, who did not develop leprosy until resident in America.
Fig. 198 – Same as Fig. 197, showing the disappearance of the facial infiltration after receiving nastin-B for some months. After being observed for nearly a year, this case was discharged as cured.
Leprosy occurring in childhood and youth has produced a deficiency in hair formation, sexual development and general physical growth. While this form of leprosy may permit the patient to live many years, the ever-increasing intensity of the disease and the suffering therefrom reduce the patient’s endurance to such an extent that he falls an easy victim to some secondary affection such as pneumonia, bronchitis, erysipelas, kidney or gastrointestinal disorders. A few die directly from obstructing leprous growths in the throat while asthenia, consequent on the excessive drain from ulcerating sores, claims a few.
Fig. 199 – Leprosy of the maculo-anesthetic type in an adult male Pole. Much improvement in general health and total disappearance of cutaneous lesions was noted while taking Hydrocotyle 3x.
The eruptive stage of anesthetic leprosy begins with erythematous or bullous lesions. The stage of incubation is generally longer than in the tubercular form, the prodromata more distinctly neurotic and the course of the eruption less varied. The eruptive macules are similar to the primary lesions of tubercular leprosy but they are less hyperemic, more pigmented and persistent and tend to enlarge peripherally while they clear in the center. Chiefly noticed upon the trunk and extremities, the lesions are round or oval in shape; at first reddish-brown in color, they later become yellow, brown or sepia color. They may remain discrete or coalesce forming more or less extensive irregular or gyrate lesions characterized by sharply defined, slightly elevated, reddish borders with pale achromic centers. The center of the patch may become almost normal in color or even a shade darker than normal and desquamation of a variable degree may show upon a fully developed patch. On the other hand the skin may present a shiny or glossy appearance as the result of atrophy of the parts. At the onset the whole lesion may be hyperesthetic but subsequently this is limited to the advancing periphery while the central portion becomes more or less anesthetic. Loss of sensation may be found in apparently unchanged parts of the skin and occasionally hyperemia and pigmentation do not occur, and the apparent primary change is the absorption of the normal pigment. Rarely the skin becomes as white as in vitiligo.
American homeopath, he directed several hospitals in New York.
Professor of dermatology.
Served as Lieut. Colonel during the 1st World War.
See his book online: American homeopathy in the world war