104 REVIEW — TROPICAL MEDICINE, ETC. 



Leprosy— Hillis' refers to Black's work on the nasal conditions which he, to some extent, 



eontiiuied anticipated, but mentions non-tuberculated or aniBsthetic cases of leprosy with reliable 

 histories in which from beginning to end there was no nasal affection whatever. 



Clift^ suggests that leprosy, like tuberculosis, may have an intestinal origin. Thus flies 

 may infect fish and other food-stuffs which under certain conditions would form a good 

 nidus for the bacillus. The benefit resulting from taking salt may, he thinks, be explained 

 by the resulting increase of hydrochloric acid helping the digestive juices to destroy the 

 germs. 



The blood in leprosy has recently been the subject of study by Bourret.^ He examined 

 ninety cases in French Guinea and found changes which, though marked, cannot be 

 considered as characteristic. The haemoglobin value is lowered, the number of red 

 corpuscles diminished and the erythrocytes frequently present morphological lesions 

 (anisocytosis, vacuoles, poikilooytosis, polychromatophilia, granular basophilia), while 

 normoblasts also occur. The absolute number of leucocytes is generally diminished, never 

 increased. In all the forms of the malady, whether or not attributable to it, there 

 frequently exists an oosinophilia which may be considerable. The relative proportion of the 

 lymphocytes is often augmented, while the large mononuclears remain almost constantly 

 below the normal. Often enough there is an eosinophile and neutrophile myelocythemia, 

 but slight in extent. 



Passing now to the question of treatment, the Lancet* notes that for many years 

 preparations of mangrove, lihizophora mangle, have enjoyed a great reputation as a cure for 

 leprosy amongst the jDeople of Cuba, and goes on to record the results obtained by Duque 

 and Moreno, which were certainly very remarkable. 



A fuller account, dealing also with other work by Padilla in Central America, is quoted 

 by Nicholson'' as follows : — 



The effects of mangrove on leprosy are as follows. At first, if administered in large doses to commence with, 

 it produces nausea, lassitude, vomiting and purging, which, however, disappear with the suspension of the 

 treatment. For this reason it is always advisable to commence with small doses, in order to gradually accustom 

 the patient to the drug. 



The first thing the patient experiences after 15 to 20 days' treatment is an unaccountable feeling of 

 cheerfulness, ajjparently without cause for same, and without doubt he has a better appetite, and the lepralgic 

 pains are not so severe ; he feels active and disposed to carry on his usual occupation. The following month the 

 patient is another man; he has put on flesh, eats well, digests well, sleeps well and works without feeling weary; 

 the spots have become somewhat rose-coloured, more so in the periphery than in the centre, and those which are 

 confluent tend to separate, leaving large intervals of healthy skin between each other ; if there are any ulcerations 

 suppuration is diminished in them, they lose their dark colour and take on a bright red hue, and the inflammatory 

 areola disappears, the Icpromata undergo a transformation, the fresh nodules are not so extensive, and the fever 

 usually present on these occasions almost entirely disappears. Following up the treatment, the improvement 

 becomes more marked, the periodic crops of le^jromata disappear definitely from the fifth to the seventh month of 

 treatment, and the lepro-tuberculomata disappear in two ways, either by becoming inflamed, painful and 

 suppurating, or else they undergo fatty degeneration and become absorbed, leaving behind them in each case a 

 white scar with a faint, rose-coloured tint. Sometimes they become encysted and calcified, necessitating their 

 removed by incision ; the ulcers about the eighth month of treatment have healed up. The anesthesia has 

 completely disappeared. At the ninth month, according to Drs. Duque and Moreno, the alopecia ceases, and the 

 eyelashes and eyebrows grow again. What is most noticeable in these patients is the return of the face to its 

 normal condition, for it would at first seem impossible that faces with a skin like parchment, which give this 

 characteristic and repulsive aspect, could return in a relatively short time to their normal condition with a fine 

 skin. In a year, according to these same Cuban physicians, the patient is generally cured. 



Dr. Padilla now gives an account of three cases which came under his own personal observation. The first 

 of these patients was under treatment for ten months, the second one for seven months, and the third for barely 

 six months, and he states that tlie first and third cases gave the best possible results ; but in the case of the second 

 patient it was noticed that scarcely any hairy down reappeared on his body, nor did his eyelashes and eyebrows 

 make much progress as regards growth. The first case occurred in a man aged 32 years, a widower, and a field 

 labourer, with no family history whatever of the infirmity from which he suiiered, which he believed he contracted 

 from a female servant who lived in his house. His two sons, one aged 11 years and the other 9 years, are both 

 healthy. 



He stated that the first manifestations that he noticed occurred about six years ago, commencing in the left 

 cheek, and about two months later in the right cheek, and these were like thick ridges which increased until they 

 covered the whole of his face, and were accompanied with painful pustule^ which afterwards disappeared. A year 



' Hillis, J. D. (December 1st, 1906), " A New Aspect of the Pathology and Treatment of Leprosy." Lancet, 

 p. 1544, Vol. IL 



« Clift, H. L. (April 24th, 1907), " Intestinal Origin of Leprosy." British Medical Journal, p. 931. 



' Bourret, B. Q. (.January 22nd, 1908). Bull, de la Soc. de Pathologic Exotique, t. I, No. 1. 



* Lancet (October 2lBt, 1905), " Mangrove Bark in Leprosy," p. 1201. 



" Nicholson, J. E. (October 2nd, 1905), "Treatment of Leprosy by Mangrove." Journal of Tropical Medicine, 

 p. 293, Vol. vm. I y y a 



