68 G. H. MONRAD-KROHN. M.-N. Kl. 



Mental Changes. 



It goes without .saying that in the course of a disease of such a chronic 

 character as leprosy mental disturbances will be seen now and again. But 

 the majority of these have probably no direct causal connection with leprosy 

 — and in practically all those cases, where a connection must be admitted, 

 the mental condition is only indirectly the result of the disease. 



It stands to reason, that the knowledge of the nature of the disease and 

 the hopeless prognosis are both apt to produce a state of depression in the 

 patients. This may, when it is not excessive, be said to constitute a normal 

 mental reaction. But it may become so excessive that it must be described 

 as morbid. According to de Beurmann there is a marked difference in 

 this respect between European and Asiatic patients. While the former are 

 very apt to show the secondary depression just described, the Asiatic 

 patients as a rule show a remarkable indifference and remain quite gay 

 (cpr. DE Beurmann & Gougerot, "Les troubles mentaux dans la Lèpre, — 

 des troubles psychiques des Lépreux", II. Leprakonferenz in Bergen 1909, 

 III. Band, pag. 181). 



It is equally obvious that the precautions that the community is forced 

 to take in the fight against the disease, are apt to influence the mentality 

 of the patients. The transport of the patients to a leprosy hospital far 

 away from their homes, is not onl}' apt to add to the depression just 

 mentioned (one often hears the most touching expressions of a nostalgia 

 which may last for years) — but in predisposed patients this transport 

 m ay be the starting point of persecutory delusions. 



It is therefore not surprising that cases of paranoia and paranoid 

 states are occasionally met with in a leprosy hospital. 



The only mental disturbance that can possibly have a direct connec- 

 tion with leprosy is the KoRSAKOFF-syndrom, which has been described by 

 DE Beurmann, Roubinowitch and Gougerot (Les troubles mentaux de la 

 Lèpre, Lepra Bibi. intern. 1906, vol. 6, fase. 2, p. 107). It seems, however, 

 to be of extremely rare occurrence. If one compares this, however, with 

 W. Harris' description of KoRSAKOFF-syndrom in polyneuritis of non-alco- 

 holic origin (cpr. Proceedings of Royal Society of Medicine, neurological 

 section 1922) one is forced to admit that the KoRSAKOFF-syndrom may be 

 found in any condition of polyneuritis, frequent in the alcoholic cases — 

 extremely rare in the cases of leprosy. Any diagnostic help cannot be 

 derived from the mental examination in leprosy. 



Summary of Clinical Findings. 



What I have described in the previous chapters are those neurological 

 disturbances which I regard as really due to leprosy. 



It goes without saying that in the course of an illness which may last 

 for 60 years or more, all kinds of complications may occur, also nervous 



