i88 DISEASES DUE TO BACTERIA 



result. Secondary infection leads to keratitis, onyx, hypopyon, iritis, 

 irido-cyclitis and total destruction. 

 Sterility is not so frequent. 



(3) MIXED VARIETY. 



Some tubercular cases develop nerve leprosy. 

 Some nerve cases develop tubercular leprosy. 

 Some advance equally. 

 Diagnosis. 



Bacilli always present in the nodular variety. In early cases look 

 in the nasal secretions. 



in the anaesthetic form the bacilli are more difficult to find. 



PROGNOSIS. 



Cure is exceptional. Periods of apparent cessation not uncommon. 

 Tubei'cular or mixed, 2 to 12 years' duration. • 

 Anaesthetic form, 6 to 20 years' duration. 



Intercurrent disease often kills. Death is seldom from the disease 

 itself. 



TREATMENT. 



None specific. Fresh air, good food, isolation, removal of child- 

 ren, light work, amusement, rural colonies. 



It is a wise procedure to emigrate the children of lepers; 160 of such 

 emigrated to Canada and not one has become a leper (Hansen). 



Surgical treatment as required for ulcers, whitlows, &c. 



Chaulmoogra oil, obtained by cold expression from the seeds of 

 gynocardia, some species. It is easily adulterated and often substituted. 

 Rub into patches, also to be given internallv 111 5-10 to v\ 30-40 t.d.s. 

 in capsules or in pill with tragacanth and soap or in emulsion. 



Limes remove the taste of the oil. 



Rogers prescribes gynocardic acid, also known as chaulmoogric 

 acid, and believed by some to be the active principle of the oil. This 

 latter contains almost certainly useless palmitic acid. 



Dr. Sandwith recommends the use of this oil by hypodermic 

 injection. 



Hot baths may be tried. 



Strychnine for nerve cases gr. -r^r> t.d.s. 



Omit treatment every seventh week and use ichthyol ointment 5 

 per cent. 



X rays have been tried, Finsen and radium. 



Hg. perchloride subcutaneously early everv other dav is useful. 



" Nastin," a neutral fat from Streptothrix leproides, combined with 

 benzoyl chlorine and made into ampoules Avith sterile olive oil, 0*0005 

 to o'ooo2 gramme of nastin, once weekly can be tried. 



