LEPRA ANAESTHETICA. (Nerve Leprosy)

Categories: Infectious Diseases

Before the development of this form of leprosy there

may be one or two years of ill-health. Usually the skin at this time

becomes in localized patches over-sensitive, sometimes there is

over-sensitiveness and special nerves, because of their enlargement,

become accessible to the touch. Those named later become tender, and the

seat of lancinating or shooting pains. This clinical variety may be

commingled in its symptoms with each of the other types. With or without

such commingling, however, there commonly is noted, after exposure to cold

or after being subject to chills first an eruption, red (erythematous)

patches, or of "bullae," size of a bean on cheeks, ears, back of the feet,

and ankles. The eruption may be outer skin covering (epidermis) and filled

with a clear tinted or blood-mixed serum, and usually occurring upon the

extremities. The scars that follow are shrunken (atrophic) patches, each

often greater in extent than the base of the original trouble, color

whitish, shiny, glazed, or better described as a tint suggesting the hue

of mica; their outline is circular and form also the dumb-bell figure by

running (coalescing) together, or juxtaposition. These scars are always

without sensitiveness (anaesthetic), and they may exist together with

spotted and non-sensitive patches upon the trunk or other parts such as

the face, hands, feet, ankles, thighs, but rarely on the palms and soles.

Neither those of the one class nor of the other, however, are disposed

over the surface of the body in lines, bands or curves, corresponding with

the distribution of the skin (cutaneous) nerves. Sometimes the ulnar and

other nerves (median, posterior tibial, peroneal, facial and radial) that

are accessible to the touch are swollen, tender, insensitive or as rigid

as hardened cords. Reddish-gray swellings may be recognized by the eye

along the nerve tract. General shrinking skin symptoms follow. The skin

becomes dry and harsh; there is little or no sebaceous product and the

skin of the face seems tightly drawn over the bones. As a consequence of

deforming shrinking (atrophy) of the eyelids, a persistent overflow of

tears, consequent eye changes follow, and a constant flow of saliva

escapes from the parted lips. The fingers are half drawn into the palm of

the hands; the nails are distorted and ulceration occurs later. These

ulcers are irregular, oval, roundish or linear in form covered with thin

blackish, flattened, tenacious crusts with soft bases, and their floors

covered with a soft debris mixed with blood, the whole insensitive to

every foreign body, and external application. At last the symptoms of

mutilating lepra (leprosy) may occur, digits or portions of the wrist,

part of hand (meta carpus) or corresponding portions of the foot may be

detached from the body. Death may occur at any time during the course of

the disease. In this form it is said to last from eighteen to twenty years

and is thus not so rapidly fatal as the tubercular variety.







Treatment. The main treatment is the isolation and segregation of all

lepers from contact with the well; wholesome laws are enforced in some

countries where leprosy prevails, and provision is made not only for the

isolation and segregation, but also for their care. On account of its

relative variety America has not yet awakened and legislation only forbids

the entry of infected persons. At Molokai, in the Hawaiian Islands,

provision is made for the care of lepers. Many of the public hospitals for

the care of the sick poor refuse to receive lepers. The child of a leprous

woman should be removed from the mother after birth and not nursed by

another woman. No medicines are known to have any curative effect. An

immediate change of residence and climate should be made if the patient

happens to live in a district where the disease prevails. A highly

nutritious diet should be taken.



The outlook. The future is in general dark for the leper. It is often of

a malignant character, and a fatal result is the rule. A change of climate

and conditions may help. Scandinavian lepers who have removed to the

United States have been greatly benefited by the change, but there is no

known cure. The isolation should be as effective as that for tuberculosis.

It is not contagious but infectious.