Treatment

Before entering into the questions relating to the direct treatment of individual cases, it is important to consider the management of the disease, en masse, that is to say, the general prophylaxis.

* In North America it exists among the Chinese in California. among the negroes in Louisiana, among the Norwegian immigrants in the West, at the village of Traca-die in New Brunswick, and in Mexico. I have personally examined a dozen or more oases in the city of New York, one of which had always resided in the State principles that underlie this are sufficiently well understood, and there is an almost absolute unanimity of opinion as to the proper course to be pursued. If a given community is to be protected from the spread of leprosy, all cases that exist in it at the time should be absolutely separated from the rest of the inhabitants. Each new case, as it appears, should be sent to join the company of unfortunates. This is a matter that could only be properly managed by efficient and strict regulations on the part of the General Government. There are, at the present time, in the United States, probably over fifty lepers, and it is time that suitable measures were taken to prevent their further increase. A central lazaretto and appropriate national legislation will secure this end. The experience of other countries, notably the Sandwich Islands, should warn us not to defer the consideration of this subject too long.

+ Especially to such countries as may be threatened with an extensive Mongolian immigration, as the disease is quite prevalent among the Chinese.

++ Report on Leprosy by the Royal College of Physicians. London, 1837.

** Etienne Brosse: La lepre est contagieuse. Far un Missionnaire attache aux leproseries. Paris, 1870.

In the management of individual cases, general hygiene claims the first attention. Good air, good food, suitable clothing, and frequent ablution have, wherever they have been availed of, contributed very materially to the amelioration of the disease, and the comfort of the unhappy sufferers. As regards the curative treatment we are unfortunately unable to speak with any great degree of encouragement. In all probability some cases of Leprosy have gotten well under treatment. The evidence on this point is too strong to be thrown lightly aside. In many cases, moreover, the disease has undoubtedly been greatly ameliorated and its progress retarded. It is not right, therefore, to pronounce every case of Leprosy necessarily hopeless, as has too often been done.

A number of drugs have been credited with being capable of rendering more or less service in the treatment of this disease. Some of these appear to have fallen into disuse. while others are of too recent introduc-tion to enable us as yet to form a just opinion of their true value. The principal indications for treatment are first to relieve the pains incident to the disease; to restore the sensibility to the Kinesthetic parts; to heal the ulcerations, if any exist, and to cause the tubercles to disappear. Second, to retard the progress of the disease, and, if possible, prevent its further development. To fulfil these indications, a number of drugs and a number of "methods of treatment" have been employed. I shall mention some of them.

Calotropis gigantea, a now comparatively unknown drug, enjoyed a certain reputation in India fifty years ago, in the treatment of this disease. The statements of its advocates will be found on page 36 of this book.

Hydrocotyle Asiatica was introduced by DR. Boilkau, himself a leper, who claimed to have cured not only himself, but also many others of the diseaae. (See page 68.) My own experience with this drug (though not in Leprosy) has satisfied me that it is an active article, and I think further experiments should be made with it by those who have the requisite opportunities.

Anacardium and Hydrarg. Chlor. Corros. - The use of these drum constitute the special features of Dr. Beauperthury's treatment, and the method of their application, with other details of treatment, have been published by Bakewell (146, 1, '70, 550), to whom they were communicated for the purpose by DR. Beauperthuy. Dr. Bakewell writes as follows:

First

"First. - A nourishing and abundant diet; salt-fish or meat, and pork are prohibited entirely, so are spirits; light wine (Bordeaux) is allowed in moderation to those accustomed to it. Fresh meat should be given every day.

Second

"Second. - The patients should live in as healthy a locality as possible, ami in the neighborhood of marshes, etc. They are required to sleep under mosquito nets, so as to prevent the stings of insects, which irritate and inflame the skin, and perhaps propagate the disease; not more than two persons are to occupy the same room; and it is better if each has a separate room.

Third

"Third. - Internal remedies, varying according to the condition of the patient, are given. The principal one is bichloride in doses of 1/15 grain twice a day. Quinine is given where fever occurs, and other remedies as occasion may require.

Fourth

"Fourth. - To remove the tubercles and promote exudation, the oil of Cashew nut,* obtained by spontaneous evaporation of a tincture of the nut, which must be well pounded in a stone or wooden mortar before be-ing exposed to the action of the alcohol. This is a most valuable application, acting slowly but very powerfully.

Fifth

"Fifth. - A strong solution of nitrate of silver and copper, made by dissolving silver coin in strong nitric acid, mixing the nitrate thus obtained with an equal bulk of distilled water. This application is sometimes used instead of the cashew on anaesthetic patches.

Sixth

"Sixth. - Frictions night and morning over the whole of the body with cocoa-nut oil.

Seventh

"Seventh. - A bath of soap and water taken before the frictions. Sometimes baths of hot cocoa-nut oil 100° F., are beneficial."