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LEPROSY. Definition

Categories: 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. Lepro
y 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.



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