592 



NA TURE 



[October 20, 1923 



sodium hydnocarpate was more active than cither the 

 former or than sodium chaulmoograte. E. L. Walker 

 and Marion Sweeney confirmed these observations and 

 showed that these fractions had a direct lethal action 

 on arid-fast bacilli as a class when added to cultures. 

 This led them to suggest a direct action of the drug 

 on the lepra i)a(illus in vivo. 



As these soluble preparations were still painful and 

 slow in their action, Rogers commenced to use them 

 intravenously, when he observed occasional severe 

 febrile reactions with inflammation of leprous nodules 

 accompanied by extensive breaking up of the lepra bacilli 

 in them, followed by gradual absorption and eventual 

 disappearance of both the bacilli and all signs of the 

 disease. The same worker next showed that a soluble 

 sodium salt of the fatty acids of codliver oil, sodium 

 morrhuate, and of soya-bean oil (sodium soyate) were 

 also effective in leprosy, although they had no direct 

 action on acid-fast bacilli in vitro. More recently, he 

 has found an increase in the amount of lipase in the 

 blood of treated cases, and Muir in Calcutta has shown 

 that this ferment decreases after a severe general 

 reaction, indicating that it has been used up during 

 the destruction of the bacilli in the body. 



Shaw-Mackenzie showed these soaps to stimulate the 

 action of pancreatic ferment in vitro on fats ; so Rogers 

 has suggested that they may act through the lipase, 

 dissolving the fatty coating of the lepra bacilli in vivo, 

 much as Dryer has succeeded in doing in vitro in the 

 case of the tubercle bacillus, a point of practical interest 

 also in connexion with the use of sodium morrhuate in 

 tuberculosis, which is still under trial. In the case of 

 leprosy large numbers of the bacilli may be safely 

 disintegrated by the treatment with apparent enhance- 

 ment of the resisting powers of the patient's system, 

 complete disappearance of extensive nodular leprosy 

 having occasionally followed a very severe febrile 

 reaction of a month or more in duration, followed by 

 gradual clearing up of the disease during the following 

 year without any further treatment. Moreover, 

 K. K. Chatterji has obtained an active preparation 

 against leprosy from mim oil, and Muir others from 

 linseed and even from olive oil, so an immense field 

 has been opened up for further search for possible 

 curative products against both leprosy and tuber- 

 culosis. 



In 1920 Prof. Dean and Dr. Hollmann in Honolulu 

 made a further practical advance when they showed 

 that ethyl ester chaulmoogrates and hydnocarpates can 

 be successfully used by the intramuscular method in 

 place of the more troublesome intravenous injections 

 of the sodium salts. Similar preparations to theirs 

 were the basis of " leprolin " issued by a German firm 

 several years earlier and used with some success in 

 leprosy by Engel and others. 



Reports from all parts of the world now suffice to 

 prove that an important advance has been made in 

 the treatment of leprosy by these various researches, 

 the less advanced cases being naturally more amen- 

 able to the treatment, and although in such a chronic 

 disease as leprosy, with a very long incubation period, 

 it is difficult to decide if actual cure can be brought 

 about any more than in tuberculosis, yet a few of the 

 earlier Calcutta cases have now remained free from 



NO. 2816, VOL. I 12] 



active signs of the disease for from five to eight year^ 



There is good reason, therefore, to hope som** ar» 



actually cured, while there is no doubt th< 



of the disease is removed in many of the r.i 



with consequent decrease of possible contagions froni:| 



them. 



Provis] 



rRKATMENT. 



The practical question now arises as to how far the 

 improved treatment can lie utilised in the st^- "■■''• 

 against leprosy. The third International I. 

 Conference at Strasbourg in July last endorsed its \ iimc, 

 and laid it down that segregated lepers should be 

 provided with the l>est treatment. Only a ver>' small 

 percentage of the total lepers segregated in India and 

 other British-governed countries are receiving its 

 benefits, however, much less the vastly greater numlxrs 

 of free lepers, including most of the earlier an 

 cases, the infective powers of which might be i 

 abolished by six months' to a year's treatment. The 

 treatment would cut short the new infections arising 

 from them among their relatives and others living in 

 their houses, and solve the hitherto unsurmountable 

 problem of dealing effectively with the early cases of 

 the disease, which it is often impracticable to scl \ 

 It aflfords the only hope of a rapid diminution of : 

 in India, Central Africa, and other countries with very 

 numerous lepers. 



For this purpose, in addition to agricultural colonies 

 for indigent and especially dangerous lepers, it will be 

 necessary to organise out-patient leprosy clinics in con- 

 nexion with as many hospitals as possible, where the 

 weekly injections can be given, on the plan developed 

 by E. Muir at the Tropical Disease Hospital. Here 

 about 100 cases are under regular treatment, and 

 much research work is being done with the \iew of 

 improving further the treatment in the leprosy 

 laboratory of the Calcutta School of Tropical Medicine. 

 By this means it should be possible to render a large 

 number of the earlier cases non-infective at a far lower 

 cost than in settlements, and to produce a decline of 

 new infections, and ultimately in the incidence of 

 leprosy, hitherto impossible to obtain. 



Unfortunately, it must in truth be admitted that the 

 United States is doing far more for its lepers in the 

 Philippines and Hawaii, both as regards segregation and 

 in applying the newer treatment, than Great Britain is 

 for her much greater number of lepers, mainly due to 

 lack of funds, especially in India and Central Africa. 

 During the last few months, however, a British Empire 

 Leprosy Relief Association has been founded under the 

 chairmanship of Lord Chelmsford, with the support of 

 a number of leading British physicians and men of 

 science, which will shortly attempt to raise the large 

 sums necessary- to remove this reproach from the British 

 nation. This has become all the more imperative now 

 that the Strasbourg Leprosy Conference has pointed 

 out the obligation we are under to provide the best 

 treatment for our segregated lepers. It applies equally 

 forcibly to the free, earlier, and more curable cases, 

 and it is to be hoped that no further time will be lost 

 in bringing the knowledge that science has now furnished 

 to the relief of those who are perhaps the most cruelly 

 afflicted of the human race. L. R. 



