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LEPROSY. Definition





Category: Infectious Diseases

Leprosy is a chronic infectious disease, caused by
what is called the "Bacillus Leprae," and is characterized by the presence
of tubercular nodules in the skin and mucous membranes (tubercular
leprosy), or by changes in the nerves (anaesthetic leprosy). These forms
are separate at first, but ultimately they are combined and there are
disturbances of sensation in the characteristic tubercular form.

History. Leprosy is supposed to have originated in the Orient, and to be
as old as the records of history. It appears to have prevailed in Egypt
even so far back as three or four thousand years before Christ. The Hebrew
writers make many references to it, and it is no doubt described in
Leviticus. The affection was also known both in India and China many
centuries before the Christian era. The old Greek and Roman physicians
were familiar with its manifestations, ancient Peruvian pottery represent
on their pieces deformities suggestive of this disease. The disease
prevailed extensively in Europe throughout the middle ages and the number
of leper asylums has been estimated at, at least, 20,000. Its prevalence
is now restricted in the lands where it still occurs while once it was
prominent in the list of scourges of the old world.

It is now found in Norway and to a less extent in Sweden, in Bulgaria,
Greece, Russia, Austro-Hungary and Italy, with much reduced percentage in
middle Europe; it is the rarest of diseases in England where once it
existed. In India, Java, and China, in Egypt, Algiers, and Southern
Africa, in Australia and in both North and South America, including
particularly Central America, Cuba, and the Antilles, it exists to a less
extent. It has been recognized in the United States chiefly in New
Orleans, San Francisco, (predominantly among the Chinese population of
that city). The disease has steadily decreased among the latter colonists
in Minnesota, Wisconsin and Iowa. Isolated cases have been recognized in
almost every state, and leprous cases are presented at the public
charities of New York, Philadelphia, Boston, etc. The estimated number of
lepers a few years ago in the United States varied between two hundred and
five hundred. It is represented as diminishing in frequency in the
Hawaiian Islands, Porto Rico and the Philippines. In the Hawaiian Islands
it spread rapidly after 1860, and strenuous attempts have been made to
stamp it out by segregating all lepers on the island of Molokai. There
were 1,152 lepers in that settlement in 1894. In British India, according
to the leprosy commission, there were 100,000 lepers in 1900.

Cause. The bacillus, discovered by Hansen, of Bergen, in 1874, is
universally recognized as the cause of leprosy. It has many points of
resemblance to the tubercle bacillus. These bacilli have been found in the
dwellings and clothing of lepers as well as in the dust of apartments
occupied by the victims.



The usual vehicle by which the disease is transmitted is the secretions of
a leprous patient containing bacilli or spores. The question of
inheritance of leprosy is regarded now as standing in the same position as
that relating to the inheritance of tuberculosis; no foetus, no new-born
living child, has been known to exhibit the symptoms of either disease.
Several cases have been cited where infants but a few weeks old exhibited
symptoms of leprosy. It affects men more than women. Infection is more
common after the second decade, though children are occasionally among its
victims. When it occurs in countries where it had not previously existed,
its appearance is invariably due to the infection of sound individuals by
lepers first exhibiting symptoms where the disease is prevalent.

Neisser states this: "The number of lepers in any country bears an inverse
ratio to the laws executed for the care and isolation of infected persons.
The disease appears to spread more rapidly in damp and cold, or warm and
moist, climates than in temperate countries. It is not now regarded as
contagious. The leprosy of the book of Leviticus not only includes lepra,
as that term is understood today, but also psoriasis, scabies and other
skin affections," The leper, in the eye of the Mosaic law, was
ceremoniously unclean, and capable of communicating a ceremonial
uncleanness. Several of the narratives contained in the Bible bear witness
to the fact that the Oriental leper was seen occasionally doing service in
the courts of kings, and even in personal communication and contact with
officers of high rank.

Symptoms. Previous symptoms: Want of appetite, headache, chills,
alternating with mild or severe feverish attacks, depression, nosebleed,
stomach and bowel disturbances, sleeplessness. The durations of these
symptoms is variable. Some patients will remember that these symptoms
preceded for years the earliest outbreak of lepra (leprosy). In other
cases only a few weeks elapsed. These earlier skin lesions are tubercular,
macular (patches), or bullous elevations of the horny layer of the skin.
It may then be divided into three varieties tuberculous, macular and
anaesthetic.





Next: LEPRA TUBEROSA. (Tuberculated, Nodulated or Tegumentary (skin) Leprosy)

Previous: KNEE JOINT DISEASE. (White Swelling)



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