In general it may be said that doubtful nodular lesions should be examined microscopically for the fungus, while in anesthetic leprosy the loss of sensation and the regularity of the enlargement of the ulnar and other nerves is diagnostic.
Prognosis – There is no doubt that incipient leprosy can be cured but it is a question whether this is due to treatment or the natural course of the disease. The usual result is fatal although there may be pronounced remissions, only leading to a renewal of the disease with reinforced vigor. The typical duration of the disease has been noted before and should always be included in the prognosis. The removal to a non-leprous country, proper food, hygiene, local and internal treatment will no doubt extend the life of the patient and occasionally result in apparent cure.
Treatment – The necessity of segregation is doubtful and there is much difference of opinion as to its real worth, except when the disease is endemic or when the tubercular form predominates. The imported sporadic cases that are found in all large cities of the world have never given rise to other and, although they should be listed and regularly examined so as to watch any developments which might endanger others, it seems cruel and unnecessarily harsh to segregate such cases if they can be properly cared for at home.
There are no specifics for the cure of leprosy but it is generally agreed that good effects follow from improved ways of physiological living. It has been my own observation in the treatment of this disease for the last ten years that much the same regime is indicated here that is found necessary in general tuberculosis – that is, a temperate climate, plenty of sunlight, outdoor exercise, plain and nourishing mixed diet, suitable clothing, regular or daily hot baths (boric acid, formalin, resorcin or sulphur) and careful inunction of the skin with an oil such as chaulmoogra, gurjun, simple linseed or olive, plus some form of medication. It is the general opinion that inunctions of oil are beneficial from the frictions rather than because of the peculiar nature of the oil. Stimulating, reducing or antiparasitic agents may be needed for their local effect, and of these the X-rays and solidified carbon dioxid for large and small areas respectively are most useful. Unna recommends an ointment containing 5 per cent. each of chrysarobin and ichthyol and 2 per cent. of salicylic acid. he further suggests resorcin in place of chrysarobin for women and children. Iodoform ointment as employed by Impey and sodium salicylate ointment as used in Norway may be needed in individual cases. Recently I have used guaiacol for the degenerating changes of the skin with good results. Surgical means may be used, such as nerve-stretching to relieve the neuralgic pains of anesthetic leprosy, or the excision of tubercles, necrosed bones or other tissue, or curetting of ulcerated surfaces. Tracheostomy or intubation for stenosis of the larynx, due to leprous growths in that location, are sometimes necessary. Galvanism and the high-frequency currents have proven useful in assisting to restore the sensory functions.
Specific therapy is an ideal for which many investigators have striven and the resulting medicinal suggestions are numerous and varied. To properly appreciate the many angles from which this subject has been approached, the reader is referred to Public Health Bulletin No. 47, published by the Treasury Department of the United States in September, 1911, which discusses at length the attempts at specific therapy in leprosy as well as the subject of the artificial cultivation of the bacillus of leprosy by the surgeons of Marine-Hospital Service. Brief mention may be made of the following: chaulmoogra oil in 3 to 80 drop doses in milk, emulsion or capsules, three times daily; the active principle of this oil, gynocardic acid, in the form of sodium gynocardate is less irritating to the stomach and may be given in doses of 1/2 to 3 grains, three times daily; gurjun oil may be administered in an emulsion composed of 1 part of the oil to 3 to 5 of lime water, the dosage of this mixture being 2 to 4 drams two or three times daily; guaiacol, equal parts with sterilized olive oil, has been recently used in a hypodermic manner, being injected intravenously; strychnin or nux vomica has been extensively used, often in connection with one of the above oils; ichthyol, carbolic acid, potassium iodid, iodin, salicylic acid, sodium salicylate, salol, creosote and arsenic have been given internally with indifferent success. Many vaccines, serums and similar preparations have been tried but only a few need mention. Carrasquilla’s serum has been extensively used with varying results but it is not now generally advocated. Antivenene (Calmette), leprolin (Rost), and nastin or nastin-B have all benefited individual cases.
There is every reason to believe that cases of leprosy, amenable to treatment, will respond as rapidly to remedies symptomatically prescribed as to any of the empiric measures just mentioned. My own observation of about forty cases, treated in series of three to five with at least ten of the therapeutic measures mentioned, supports this view, because of the five patients discharged as apparently cured, three received Hydrocotyle 3x, Sepia 6x, and Arsenicum iodatum 3x, without any other internal treatment and only the simplest of antiparasitic and cleansing methods. The other two cases received chaulmoogra oil and nastin- B. My experience leads me to believe that the best hygienic measures possible, including a change of climate and other anti-tubercular measures, as well as the use of Salicylic acid, solidified carbon dioxid and the X-rays externally, with the internal administration of chaulmoogra oil, strychnin, nastin-B or the indicated remedy is the best treatment. Other remedies that might be indicated are Arsen., Aurum., Murex, Calcarea, phos., Kali brom., Lachesis, Mercurius, Nit. acid., Pet., Rhus tox., Secale and Silicea.
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