LEPRA ANAESTHETICA. (Nerve Leprosy)

Category: 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.

Next: HYDROPHOBIA
Previous: LEPRA MACULOSA

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LEPRA ANAESTHETICA. (Nerve Leprosy)