REVIEW — TROPICAL MEDICINE, ETC. 105 



afterwards he had more spots, which spread to the nose and oars, taking on a blackish tint with scales which had Leprosy — 



disfigured his nose, and some ulcerated nodules on his ears, and also scattered over many parts of his body, continued 



including his nails, and certain affected parts were also attacked by local inflammation. Dr. Padilla diagnosed 



the case as one of tubercular leprosy in its third stage, and he commenced treatment by 30 grammes of mangrove 



boiled in 120 of water, to be taken daily; this was done for twelve days. For another similar period the dose 



was increased to 45 grammes daily, and then for another ten days to GO grammes a day. After this the fluid 



extract was used, commencing with 20 grammes daily, the dose being gradually increased up to 45 grammes in a 



month's time ; a great improvement was now observed, including the reaijpearanee of downy hair, the swelling of 



the feet disappeared, the patient enjoyed a good appetite and slept well, was very cheerful, and was now able to 



attend to his usual occujDations. The fluid extract was now changed for the dry in doses of 2 grammes daily, 



which wore gradually increased up to 7 grammes in the next two and a half months. Eleven months after the 



commencement of the treatment the patient was the first to ask for its suspension, since he felt and appeared to 



be thoroughly restored to health. 



The treatment has also been tried in the Havana leper hospital during more than two years, on 17 cases, the 

 drug being given internally and applied locally, and though the results obtained were not equal to those recorded 

 by Duque and Moreuo, considerable improvement occurred in every case, one being completely cured with 

 disappearance of Hansen's bacilli. 



Diesing^* reports cures by means of subcutaneous injections of iodoform. He 

 employs a 30 per cent, emulsion of iodoform in olive oil and injects from 2 c.c. to 8 c.c. of this 

 daily under the skin, at first in the neighbourhood of the infected areas, and later, when the 

 lesions are healing, in some suitable situation. The dose is increased fairly rapidly to 

 8 c.c. and the desired result is obtained in about six weeks. Tincture of iodine may also, 

 with advantage, be painted on externally. It is suggested that either the amount of iodine 

 liberated is sufficient to disinfect the whole body, or that the bacilli, having been killed by 

 the iodine, produce or set free antibodies, which eventually attack and destroy all the 

 organisms present in the body. 



Thompson- reports a case in Australia which failed to benefit by the administration 

 of gurjun oil, but was greatly improved, indeed was very nearly cured by chaulmoogra oil 

 (Oleum (jynocardmm) and frequent hot baths. The dose of oil at first was 45 minims a day 

 given in three doses. This was finally increased to 270 minims and for a time was combined 

 with strychnine. A good deal of benefit, however, may have been due to causes inherent in 

 the patient. In the account of the ease, Thompson mentions two special methods of 

 examination which can be employed to test whether leprosy is or is not present. These we 

 quote as likely to be useful, and they are said not to be generally employed : — 



(a) The way is systematic examination of the peripheral nerve trunks as a matter of routine. In the 

 accounts referred to these are most often omitted from mention ; and if their condition be noted, then it is done 

 only by way of adding one additional item to the complex of signs and symptoms fi'om which the diagnosis must 

 be deduced. But I now submit that such alterations as have been mentioned above, however (hardness, 

 inseusitiveness, increase in size, etc.) suffice by themselves to suggest a diagnosis of lepra when they are exhibited 

 in a person who otherwise is in apparent good health. In declared cases, such alterations are always to be found 

 if they are looked for ; also they occur very early, and I doubt whether they may not be the earliest sign of 

 infection. 



(h) The means referred to is the subcutaneous injection of a salt of pilocarpine. I think that the appearance 

 under the influence of pilocarpine of more or less dry areas of skin, intermingled with areas over which sweating 

 occurs in normal degree, always affords strong ground for suspecting leprosy, while dryness of the wrists and 

 hands and of the ankles and feet, when it occurs under that influence, is decisive. 



Neumann^* combined chaulmoogra oil with salol and iothion. If not well borne by 

 the stomach resort may be had to subcutaneous injection. This may rarely induce 

 pulmonary embolism (Tourtoulis Bey), but it is a transient affair and disappears 

 spontaneously. 



A suggestive lecture on leprosy is that by Thompson,^ in which he alludes to several 

 interesting points : — 



1. The lepra bacillus is not found in all of those lesions which, clinically and pathologically, denote the 

 leprous process ; thus it has been found absent from nerves which were markedly involved, and also from other 

 lesions, despite numerous and careful examination by competent observers. " Hence," says Thompson, " while we 

 have for the present no classifled proof that the Bacillus lepra is the cause causans of leprosy, occasionally cases are 

 met with clinically in which, according to common experience, the bacillus should be easily demonstrable, and in 

 which, nevertheless, it cannot be found." 



' Diesing. £crl. Kim. Wock., June 7th, 1906. 



'' Thompson, J. A. (December 1st, 1906), "Lepra Tuberosa — Treatment with Chaulmoogra Oil." Lancet, 

 p. 1506, Vol. II. 



" Neumann. Quoted ia Medical Annual, 1907, p. 353. 



* Thompson, J. A. (November 30th, 1907), " Notes on Leprosy." Lancet, p. 1.514, Vol. II. 



* Article not consulted in the original. 



