1664 



LEPROSY 



The microscopical examination would give more than 50 per cent, of positive 

 results. 



Some authors recommend the blistering of the skin, and examination of 

 the liquid of the blebs for the presence of Hansen's bacillus. Thompson 

 recommends for diagnostic purposes the injection of pilocarpine, with the 

 view of discovering dry areas in the sweating skin. 



Differential Diagnosis. — In countries where leprosy is endemic, 

 other diseases are liable to be mistaken for it. One of the diseases 

 most frequently mistaken, as has been pointed out by Powell and 

 others, is framboesia, which may be recognized by the presence of 

 the Treponema pertenue and the framboesiform appearance of the 

 nodules. Leucodermic patches and morphoea are also occasionally 

 mistaken for leprosy, but in such conditions there is no anaesthesia. 



Prognosis. — The prognosis is not good. The probability of a 

 permanent cure is slight, but the disease may last a long time. 

 Four to twelve years is laid down for the mixed or tubercular 

 leprosy, and longer for the maculo- anaesthetic, and during that 

 time a great deal can be done by appropriate treatment; and, 

 indeed, the disease may be stopped for the time being, only, 

 usually, to recur again. It has been shown by Lie that, even when 

 all the skin eruptions have disappeared, and the patient is only 

 troubled by anaesthesia, and the atrophy of the muscles, and may 

 be thought to be cured, still the bacilli are present in the nerves 

 and spinal cord. 



Leboeuf from his recent investigations in New Caledonia has come to the 

 conclusion that .in a certain number of cases showing slight symptoms, an 

 actual cure takes place. 



Treatment. — So far no specific treatment has been found, though 

 Carrasquilla attempted to prepare a serum by the injection of the 

 blood of lepers into equines, and Abrahams and Hermann by 

 inoculating the juice from lepromata into an animal. These sera 

 have been found useless. Rost prepared a substance, which he 

 called ' leprolin,' on the lines of tubercuhn, but, unfortunately, 

 the bacillus he was using was not the leprosy organism. Clegg's 

 vaccine and B ay on 's extract of Kedrowsky's strain have not been 

 very successful. Tuberculin has been tried without success, and, 

 in fact, very serious sj'mptoms may follow its injection. 



Chaulmoogra Oil. — As regards symptomatic treatment, there is 

 no doubt as to the great value of Chaulmoogra oil, which is said to 

 be obtained by cold expression from the seeds of some species of 

 Gynocardia {vide infra), but may be adulterated with other oils,, 

 especially that of Hydnocarpus wightiana, or may be altered by being 

 expressed when heated. It should be rubbed into the diseased 

 patches, and also given internally in doses of 5 to 10 minims, 

 working up gradually to 30 to 60 minims, in capsules, or in a pill 

 with tragacanth and soap, or in an emulsion, or as Engel-antileprol 

 capsules. To remove the after-taste a lime can be sucked. This 

 treatment must be persisted in for a very long time, and should be 



