106 KEVIEW — TROPICAL MEDICINE, ETC. 



Leprosy — 2. Supposing it be the cause, it would seem that every leper, or at least every leper Vf ho discharges and scatters 



conliiiiuxi ''^P^sy bacilli, must be a danger to others. But this does not follow; and observed facts show that some third 

 factor is indispensable. Indeed by Dr. Thompson's arguments one is reminded of the X, Y and Z of Petteiikofer 

 as regards cholera. 



3. Observations in New South Wales have shown that avoidance of association with any leper is not enough 

 to avoid attack (.sec, however, Black's paper, previously quoted, on concealed nasal infection), while on the other 

 hand clo.se association with lepers is a matter of very little practical importance at most. Indeed the evidence 

 available makes it more probable that the infection of leprosy is received by man from his environment' rather 

 than from the sick. 



4. It is quite possible, nay, even probable that infection may be taken by ingestion, and this despite the work 

 of Woit and others who are inclinecl to beUeve that the infection is taken up by the skin and is essentially as 

 ascending neuritis which leads ultimately to generalised infection of the body. Facts against this view are given, 

 the most important being that in cases of almost universal leprous cedema, tactile pressure, heat and pain 

 sensations sometimes ajjpear to be perfectly normal, even after four or five years of manifest disease. 



5. Evidence can bo advanced against the hypothesis that the infection is commonly received by the nasal 

 mucous membrane. Cases are not uncommon in which no evidence of such affection can be got. Thompson's 

 experience is that the nasal lesions supervene earlier or later in the course of illness, and only according to the 

 patient's inaccurate observation seem sometimes to have preceded the obvious signs of a generalised infection. 



6. The successful inoculation of apes by Nicolle, ' if confirmed, may yield an increase in our knowledge. 



7. After further, none too favourable, comment on the ohaulmoogra oil treatment, the "nastin" treatment, 

 introduced by Deycke Pasha and Raschad Bey, is mentioned, " nastin " being a substance extracted from a special 

 organism found in leprous tissues. 



Eecently full details of this treatment, as modified by Deycke, have been published. ^ 

 The organism in question is not the lepra bacillus which could not be cultivated, but a form 

 of streptothrix which has been termed — Streptothrix lepruides. " Nastin" is a fatty principle 

 extracted from this organism. When injected into lepers it gives rise to a reaction similar 

 to that produced by tuberculin in tuberculosis. Now it was found that benzoyl chloride, 

 even in the cold, deprives tubercle bacilli of fat in about twenty minutes, and does so 

 instantaneously and completely after slightly heating. (Tubercle bacilli were used in the 

 preliminary, experimental work, as they could be cultivated). The treatment briefly stated, 

 is to employ benzoyl chloride and " nastin " together. As Deycke says : — 



Numerous trials having demonstrated that pure benzoyl chloride solutions are quite ineffective specifically, 

 vee can only assume that benzoyl is the really active substance which acts direct on the lepra exciter; 

 it requires, however, in order to get at the liacillus at all and not to be wasted in other directions, the 

 guidance, so to say, of the otherwise thoroughly passive " nastin," which charges itself in oily solution with 

 benzoyl chloride ; it is not, however, a chemical union but rather a state of simple solution ; in this way 

 benzoyl chloride is protected from being prematurely or uselessly used up. The " nastin " is carried to the lepra 

 bacilli, to which, owing to its near chemical and physical relation, it attaches itself, and then benzoyl can fully 

 display its anti-bacterial action in the fat-removing sense. When deprived of fat the lepra bacilli seem to be 

 doomed; the human organism then effects with comparative ease the further dissolution and ultimately the 

 complete destruction of the bacteria nuclei. Benzoyl-nastin, then, is au agent which directly acts on lepra bacilli. 

 When administered in appropriate doses it brings about, if not in every case complete cure, at least the arrest of 

 the disease in all but the most hopeless. The benzoyl-nastin solution is put up in ampoules containing each from 

 0-0005 to 0-002^ nastin in sterilised olive oil. One such dose is injected hypodermieally once a week. No 

 reaction is observed with the smaller doses, but with the larger reaction occasionally takes place. It is not 

 desirable to induce a marked reaction. In favourable cases, aiSer some weeks or months the lesions gradually 

 disappear. Kolle & Co., Biebrich am Rhein, have undertaken to prepare the material in a form ready for use. 



It must be evident from these notes that an investigation on leprosy as it occurs in the 

 Sudan might well repay the observer and furnish useful information. It is one of those 

 diseases about which the last word is far from having been spoken, and, both as regards 

 etiology and treatment, remains in an unsatisfactory condition. My own experience of 

 leprosy is too slight to justify any comments upon a disease, which, while not very common, 

 is by no means rare in the Sudan. It is said that there are between 30 and 40 known cases 

 in Omdurman, but, as far as I can determine, the disease is more prevalent in the Kassala 

 Province and in certain parts of Kordofan. 



As a rule, nothing is done to control it, but cases are noted, and in Khartoum the disease 

 is notifiable. It is very seldom, however, that we hear of a case. 



In the light of recent work and observations it is questionable, apart from the benefit 

 which patients derive, if leper hospitals do much good, at least as regards preventing the 

 spread of the disease, in a country like the Sudan. 



' Nicolle, C. (May 15th, 1906), "Recherches Experimentales sur la Lepre." Annals de Vlnstitut Pasteur, 

 p. 389, Vol. XX. 



^ Deycke Pasha (April 4th, 1908), " A Lecture on a Specific Treatment of Leprosy," liritish Medical 

 Journal, p. 802. 



^ Presumably of a gramme. — A. B. 



