Though it is admitted that the lepra is most commonly a topical disease, yet, from the thickness of the scales, and from the chief seat being in the cutis vera, topical remedies alone scarcely affect it. Medicines, therefore, which excite the action of the cutaneous vessels are chiefly of service. The principal of these is mercury and antimony. The most powerful mercurial is undoubtedly the hydrargyrus muriatus, which often succeeds. It is the active ingredient of Spilsbury's drops, which are highly celebrated; and the same remedy would be more celebrated in regular practice, could the scientific physician condescend to adopt the pompous boasts of the empiric, or was the same confidence placed in the man of experience and judgment, as in the pretending illiterate quack. Other mercurials are also useful, but perhaps not in an equal degree. Antimonials alone will not cure the complaint; but with calomel, as in the pill of Dr. Plummer, they will often succeed, if the calomel be not triturated too long with the sulphur auratum. We have usually directed it to be added to the mass, after the other ingredients were united. The advantages of these medicines are assisted by the warm diaphoretics of the vegetable kingdom, as the mezereon, the elm bark, the sarsaparilla,the guaiacum, and sassafras. We place them in the order of their activity, for the mezereon is most effectual; but combining them, as in the Lisbon diet drink, renders them more useful.
The mineral acids have lately succeeded in removing slighter kinds of this disease, and we think we have found them more effectual than the aqua kali puri recommended by Dr. Willan. The tincture of cantharides is better adapted to relieve tettery eruptions than lepra; in the latter we believe it very generally fails. Every plan of cure we have found greatly assisted by a milk and vegetable diet, interposing, every two or three days, a purgative of neutral salts. This method also most effectually prevents a relapse.
We need scarcely mention many other remedies recommended for this purpose, as the water dock, if this be really the herba Britannica; the dulcamara, which seems to have succeeded with Dr. Crichton; the cucumbers, recommended by Willis; the roots of hellebore, particularly the black hellebore, used by the ancients, and particularly noticed by Oribasius. The flesh of vipers, or of chicken nourished by it, will scarcely at this time be trusted, though highly commended by the same author.
See Aretaeus, iv. 13; Lorry de Morbis Cutaneis; Mercurialisde Morbis Cutis; Falconer in the Memoirs of the Medical Society of London; London Medical Transactions, vol. i. and ii.; Medical Observations and Inquiries, vol. i. p. 201; London Medical Journal, vol. i p. 94; Willan on the Diseases of the Skin, order ii. vol. i. p. 112, etc.
Lepra Arabum; usually considered as synonymous with the Elephantiasis, q . v. See also Lepra.
Lepra Graecorum,alba, nigra,and impetigo of Cel-sus. See Lepra.
Lepra ichthyosis. Fishy leprosy; albaras nigra of Avicenna. This term is often applied by Avicenna to elephantiasis, and we think, with Dr. Willan, that the albaras nigra of the Arabians, and the black morphea of the Greeks, are varieties only of elephantiasis. See Alphos.
The lepra ichthyosis is a more general affection of the whole skin, while the lepra graecorum appears in patches. The name is derived from the imbricated situation of the scales, which resemble those of a fish; but round the elbow and knee they are round, prominent, and small. The neck of the scales is small, but they are flatter as they rise, and often very hard and sharp, rendering the parts hard and brittle. On the inside of the arms and thighs, in the bending of the knees and elbows, and wherever the skin is thin, there are no scales. The scales are sometimes intersected with white furrows, and the surface is often broken by inflamed and painful boils.
If the scales are picked off in warm water they do not again return, but the skin beneath is dry and hard. It must, however, be often moistened, and rubbed as much as it will bear without pain. A disease of this kind is described in the fourteenth volume of the Philosophical Transactions (Shaw's Abridgement, iii. 43,) in a letter from the famous Lewenhoeck, and another in the thirty-seventh volume (Abr. vii. 543). The sequel of this last case is given in the forty-ninth volume, and the disease there appears to be hereditary. A complaint so closely interwoven with the texture of the skin would be probably intractable; and the only method of relief is that mentioned, viz. drawing out the scales after maceration in warm water. Mercury has been tried without success. A less degree of this complaint occurs in worn out constitutions, in anasarca, etc. where it appears to be only an enlargement and thickening of the natural scales of which the cuticle consists.
Lepra nigricans differs from the Lepra grae-corum, q. v. in colour, and in appearing as a disease more strictly connected with the constitution. The spots are smaller in size, the border livid, and the incrustations, which are thin, seem to derive their hue from the lividness of the skin below. When the scales are removed they are not so soon restored, and the discharge is bloody. It affects persons exposed to great fatigue, in damp situations, and has been considered as the true lepra in constitutions where the blood is greatly-dissolved. The remedies of lepra are useless or injurious; and bark, mineral acids, with sea bathing, contribute to the cure. The black scurvy of the West Indies seems to be the same disease, though like this, allied to elephantiasis, since a numbness is felt in the fingers and toes, the voice is hoarse, and fever supervenes.