Report on leprosy / by the Royal College of Physicians, prepared for Her Majesty's Secretary of State for the Colonies, with an appendix.

  • Royal College of Physicians, London
Date:
1867
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Licence: Public Domain Mark

Credit: Report on leprosy / by the Royal College of Physicians, prepared for Her Majesty's Secretary of State for the Colonies, with an appendix. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    on the ears, nose, fingers, and toes. Suppuration ensues, leading to contraction of the small joints, or these become destroyed by sloughing ulceration. A fatal diarrhoea generally terminates a miserable existence. “ The anaesthetic variety is, I think, comparatively rare in Ceylon. It commences witli impairment of general health. Vesicles form in different parts of the body, which lead to destructive ulceration, attended with falling off of the hair and general etnaciation. The articulating processes of joints sometimes become absorbed, leading to anchylosis. Diarrhoea is generally the fatal termination of this variety also.”^—{H. One of the respondents, in his description of the disease, says:— “ The symptoms of this disease are such that, in various parts of the body the skin exhibits circular scaly patches, is thickened and elevated ; and that, in process of time, the patient suflers from blisters in the fingers and toes, followed by ulceration. In a subserpient stage, excavated ulcerations appear in the soles of the feet, after which, exfoliation of the smaller bones in the diseased parts takes place.”—{J. G.) Besides the tubercular and anesthetic forms of the disease, mention is made of a third kind, of which the only symptom is the whitening of the skin, in small spots or i)atches at first, subsequently extending over a great ])art or the whole of the surface, and which is seldom attended with ulcers or other physical suffering. It is regarded as the white Jewish leprosy, and is very common in Ceylon, particularly in the N.W. province. The hair on the affected parts becomes quite white from the very beginning of the disease. Bombay Presidency.—Leprosy is well known in this presidency, including Aden; but it is said to be rather uncommon in Scinde. a. Those observers who write from sufficient experience of the disease distinguish two forms of leprosy, and Dr. H. V. Carter (whose replies are much fuller than any others) speaks of three varieties, viz., first, white leprosy, or shvet kusta, probably a variety of the leuke of the Greeks, the baras or beres of the Arabs; it is also called khoor by the Sindees : second, guleet khusta, sunbahiree, of the Hindoos ; it corresponds with aneesthetic leprosy, articular leprosy, &c. : third, tubercular leprosy, elephantiasis, leontiasis, &c., of the Greeks, the lepra of the translators of the Arabian writers, the da-al-asad (lion disease) of the Arabs, and the ructa kusta, ructa pitia, maha viadhi, of Hindoos. The first and second forms are commonly confounded under the name of white leprosy ; the third all agree in naming black leprosy. h. The unanimous opinion is that the varying forms of leprosy are merely different phases of one common morbid state. It seems to be not uncommon for a leper to be affected with two forms at once. Dr. Bell, writing from the southern Muratha district, while confessing that his ex[)erience of leprosy has been extremely limited, says, “ I had always been of “ opinion that there were two forms of the disease, viz., white and black leprosy, but from “ careful investigation I how find that there is no atfinity between them ; that which I “ regarded as white leprosy is a distinct disease, never passing into the jujam, or leprosy “ proper of the natives. The Mussulman name for it is buras (baras), the Murathee “ kode. In character and appearance it strongly resembles the lepra vulgaris of many “ authors.”—{Dr. StovelL) c. In reply to tliis query. Dr. Carter refers to his pamphlet on leprosy, already forwarded to the Royal College of Physicians. The following is a summary of the symptoms he enumerates, with a few additions from Surgeon Steinhaeuser’s replies:— Form 1.—An eruption on the skin, accompanied by anaesthesia. Form 2.—Anaesthesia of the skin of the face, ears, and extremities, followed in the latter case by atrophy, instertitial absorption, and occasionally ulceration of the benumbed parts, notably of the fingers and toes, with little or no constitutional disturbance. Large circular superficial ulcers may form on the lower extremities. The affected finger and toes become contracted, the joints enlarged, the ends of the fingers broad, flat, or clubbed. Form 3. Tumefaction, or tubercular thickening of the skin, principally of the face, also of the extremities; less marked on the trunk. The affected skin is discoloured, dark- bronzed, shining, its sensibility much diminished or entirely lost. The mucous membrane of the mouth ultimately becomes affected, and the voice altered. Contraction of the fingers and toes is a frequent symptom, and the j>halanges may drop off from ulcerated fissures forming over the articulations, or from sphacelation supervening on ulceration ; the entire hand or foot may thus be lost. The constitutional disturbance is much greater in this than in the previously described form. The eruption characterising form 1 is thus described in Dr. Carter’s pamphlet:— “ Patches or spots of a circular or annular form, size £ in. to 3 in. or more in diameter; edges raised, of a pinkish hue, free from scales, slightly cracked or wrinkled, centre depressed, pale, dry, glistening; a tendency to spread and join so as to cover larger spaces. The centre The names of the respondents are not given in full.]