It has been said that leprosy may be communicated by vaccination, but if so it must be infinitely rare and scarcely worthy of being taken into account.
Prognosis.-the prognosis is uniformly unfavorable-that is, when the disease is left to its natural course. Spontaneous recovery, if it ever occurs, is extremely rare. A few cases of cure have been reported, but a shade of doubt hangs over them. Mitigation of the affection, and even abeyance of the symptoms for a time, are by no means uncommon.
Treatment.-Good food and good hygienic surroundings are of the first importance in the treatment of leprosy. Strychnine and chaulmoogra-oil are highly recommended by the old school. They claim that with these four means at command the majority of cases of leprosy can be greatly benefited. They give the drugs in full doses, the oil being applied externally as well as internally.
Surgeon-major Peters gives as the result of two years’ experience at a leper asylum in India, with twenty-nine cases, improvement in all the cases by the following plan: The patients had to rub the body for two hours early in the morning with Carbolic oil, 1 to 40; then bathe in warm soap and water. Afterwards an emulsion composed of Gurgium oil and lime water was rubbed into the affected parts only, any ulcerations being filled with cotton smeared with the same. Under this treatment the ulcers healed rapidly, while the anesthetic parts and nodules remained unimproved. They, however, were benefited by Cashew-nut oil rubbed on to blistering. Internally, the remedy administered was as follows: Rx. Chaulmoogra Oil, m.v.
Sodae Bicarb., gr. v.
Aquae Menthae Pip., j.
M. Size of dose not stated.
Locally, warm baths with Gurgium oil are highly recommended.
The principal homoeopathic internal remedies are Hydrocotyle, Hoang nan and Piper methysticum.
Others may be indicated as follows: –
Anacardium.-Numbness and feeling of pains and needles in affected parts, which are cold; patches of raised and hardened skin on face and arms; perfect anesthesia of affected parts; weakness and prostration.
Alumina.-Copper-colored tubercles in face; leprous spots on legs; lips swollen; nose heavy; husky voice; Hyperesthesia; ulcers on plants pedis.
Arsenicum.-Yellow or white spots; tubercular swelling in nose; burning ulcers at the ends of the fingers, at the toes, soles of feet, navel, cheek; raised up tubercles; loss of hair and eyebrows; livid tubercles on any part of the body; Hyperesthesia and anesthesia alternating; general prostration.
Arsen. iod.-Pricking sensation in the skin; loss of the voice; enlargement of the glands; hoarse cough; falling off of the fingers and toes; ozaena; tubercles dirty looking.
Arum.-Melancholy disposition; discharge from the nares very offensive; absorption of the bones of the nose; has no desire to talk about sickness.
Calotropis gig.-Tubercular leprosy; lassitude, indisposition to move; loss of energy; apathy and obstruction of the capillaries; intolerable itching over the whole body.
Carica papaya.-Tubercular leprosy.
Colocynth.-Desquamation of the whole epidermis; abscess of axilla.
Crot..-Swelling of the limbs or body; spots appearing like gangrene.
Cuprum.-Leprous eruptions; cramps; suffocating spells.
Graphites.-Leprous spots, coppery, annular, raised on the face, ears, buttocks, legs, and feet; ulcers on toes, crusts in nostrils; skin cracks and discharges a sticky fluid.
Hydrocotyle.-Well-marked cases of tubercular leprosy; leonine face; nose flattened and swollen; lobes of the ears pendulous and swollen; ulcers in the alae nasi and corners of the mouth; ears discharge; hands and feet swollen so that fingers and toes spread apart; itching of any part of body; feeling of lassitude; yellowish or reddish spots on the trunk and extremities.
Iodum.-Emaciation marked; swelling of the glands; when mercury has been taken in large quantities; loss of voice and hoarseness; voracious appetite.
Kali bichrom.-Brownish colored spots; ulcers with an unhealthy look; blisters on the extremities; little boil or pustules on any part of body; thick, tough discharge from nose; hard plugs in nose; thick, yellow, putrid discharge from the ears; ulcers on tongue and on cornea.
Kreosote.-Soreness on the nose; swollen gums; painful ulcers; wheals like urticaria; numbness in different parts of the body.
Lachesis.-Spots yellow, red, green, lead and copper colored, pale livid; hard and pale swelling; large boils; ulcers surrounded by nodes and vesicles; the muscles fall off in shreds from the bones; bloody serum discharge from the nose, ears and mouth; obstinate ulcers with black spots in the granulations.
Madaru album.-The whole surface of the skin becomes leprous; livid and gangrenous tubercles; thickening of the whole skin.
Mercurius.-Falling out of the teeth; absorption of the small bones; swollen gums; sore tongue; flat indolent ulcers.
Natrum carb.-Spots and tubercles all over the face, arms, thighs, legs, which ulcerate; ulcers in the nostrils and on the heels.
Petroleum.-Tubercles on the face; herpetic and tuberculous spots on the body; ulcers of fingers, tibia; unhealthy skin with brown spots; skin dries and forms deep cracks; falling out of hair; Hyperesthesia of scalp and ears followed by anesthesia; hoarseness, suffocating cough, numbness of extremities.
Phosphorus.-Later stages of the disease; brown spots on an even base; boils; spots like blood blisters on the body; tubercles on the trunk, buttocks; thick patches on face and arms; discolored borders around the white spots; hair falls out; tension in the fingers, and dullness towards the end; great debility with increase of sexual desire.
Rhus tox.-Scalp sensitive, cannot bear to have the hair touched; pulsation in the ears; loss of smell; swollen face so that patient is not recognized; tubercles with sharply defined margins; bright red skin, violent itching; hardness and thickening of skin on any part of body.
Scale.-can hardly talk, the tongue will not respond to the will; fingers and toes drop off; falling out of the hair; eyes look sunken; cold, dried-up-looking skin.
Sepia.-Swelling of forehead, around temples; face thick, covered with tubercles; leonine face, pendant ears; eyes red, dull, weeping; purulent discharge from nose; tubercles and spots all over the body; gnawing ulcers on fingers and toes; excoriation at the tip of tongue; discharge from the swollen ears; nose and lower lip swollen; red herpetic spots at the elbow and hip; herpetic sores; white spots and ulcers on the articulations of the fingers; coppery tubercular spots all over the body, especially on the buttocks, arm-pits; tubercles on the face, trunk, buttocks, prepuce; brownish spots on face; skin peels off from hands and feet; nails look dried up and deformed; falling out of the hair and eyebrows; loss of smell; breath offensive.
Silica.-Induration of nose, with ulceration and discharge; palsied hands; white spots on cheeks; coppery spots and hard tubercles on testicles and buttocks; ulcers at tips of fingers; shortening of the hamstrings.
Sulphur.-The usual antipsoric indications.
Woorali.-Obstinate boils that will not heal; slowly forming and suppurating pimples; dirty looking skin; blood oozes through the skin; tubercles on nose; stoppage of nose, with swelling of parts, falling of the hair; swelling of the lobes of ears; falling out of the teeth; discharge of matter from the years; tonsils inflame and suppurate.
Hura Bras., Guano, Helleborus foetidus and Veronica may be compared.
Morvan’s Disease.
Morvan’s disease must be differentiated from Sclerodactily, from Lepramutilans, and from symmetric gangrene of the extremities.
The analgesic paresis with panaris of the superior extremities was first described by Morvan. The patient complains at first of neuralgiform pains in the fingers, which are soon followed by a paretic state with muscular atrophy, more or less pronounced, in the hands and forearms, sometimes spreading through the whole arm and other parts of the body. There is at the same time analgesia and anesthesia, especially for the touch, for pain and temperature (here it is necessary not to mistake it for syringomyelia, where there is no anesthesia, but only a relative analgesia and especially thermo-anesthesia). This state is followed by panaritiae, which start, like any other plain panaritium, with redness, heat and swelling, but it soon shows its malignant character, as necrosis of the bone follows, destroying not only the upper phalanx, but sometimes also the others, resulting in mutilations. We meet here also multiple panaritiae, attacking nearly all the fingers, which may follow one another at shorter or longer intervals, so that years may intervene between them. Though the first panaritium may be painful, the subsequent ones are usually painless. Trophic troubles are more or less observed, as more or less deep rhagades, ulcerations in the folds of the skin, extending to the tendinous sheaths, which are bathed in suppuration, but all is of an indolent character. The nails fall off or become deformed as in no other affection. Finally the whole hand becomes livid and its temperature below the normal.
