23,6 Samson and Limkako: Creosote in Leprosy 521 



one of the last group had it three times. There were, therefore, 

 seven instances with plain esters and twenty-seven with the 

 creosoted, occurring in 0.26 and in 1.2 per cent, respectively, 

 of the total injections, a comparative ratio of nearly 1 to 5. 

 This relative frequency with the creosoted preparations is in 

 spite of the fact that the average dose used has been somewhat 

 less than that of the plain drug. 



SIMPLE FEVER 



An unusual effect which was observed only at the beginning 

 of the work, in patients receiving the creosoted preparations, 

 was a quick, temporary rise of temperature. With noricreo- 

 soted ethyl esters slight rise of temperature is often found to 

 occur and to persist for several days after an injection; indeed, 

 slight hyperpyrexia, of less than one degree, seems fairly com- 

 mon in lepers ; but the patients themselves are not aware of it. 



From one to four hours after injection of the creosoted prep- 

 arations the patients frequently complain of a sensation of 

 heat, dizziness, and abundant perspiration. The face is flushed 

 and the pulse slightly accelerated, the rate varying from 85 to 

 100 per minute, and the temperature increased. This has 

 almost invariably been between 37.1° and 37.5° C, seldom 

 reaching 37.8° C. This more severe reaction, as in the case of 

 the local reaction, was seen only in the early stages of the work. 

 After a number of injections, usually three to five, it no longer 

 occurred. 



LOCAL REACTIONS 



Workers in India believe that, to get the best results, the 

 administration of antileprosy drugs should be pushed until some 

 degree of lepra reaction, that is, apparent activation of one or 

 more of the lesions, with or without fever, is produced. This 

 reaction, the mechanism of the production of which has never 

 been explained to the satisfaction of all students of the disease, 

 occurs universally in both the treated and the untreated lepers. 

 It cannot be doubted that the chaulmoogra ethyl esters often 

 serve to excite the lepra reaction. Table 4 shows the relative 

 frequency of lepra reactions in the four groups of our series. 



From Table 4 it is seen that, on the basis of total number of 

 injections given, there was no greater incidence of lepra reac- 

 tions in the creosote groups than in the plain. In fact, Group 

 II gave the highest per cent, 3.3, while the others were almost 

 identical, 2.5, 2.4, and 2.5. However, in the actual number of 

 persons reacting there is a distinctly higher rate for Groups 



