(From Lepra 4680 a scale). The leprosy. See


The leprosy is a chronical disease; in warm climates infectious, but not evidently so in cold countries; though its infectious nature was formerly suspected, and the unhappy victims separated in distinct establishments from the rest of mankind. Dr. Cullen places this disease in the class cachexia, and order impetigines; defining it the skin rough, with white, furfuraceous, chapped eschars, sometimes moist underneath, and pru-riginous. Of the only species known, Sauvages notes six varieties; but the lepra Graecorum and the lepra ichthyosis only occur in this country.

The leprosy of the Greeks has been very often confounded with the lepra Arabum, which, however, is a very different disease, and already noticed in the article Elephantiasis, q. v. The latter appears to be rather a disease of the constitution, and affects the hair, not only of (he head, but over the whole body; attended with deep ulcerations, loss of sensation in the swollen parts, and foetid sweats. The lepra, on the contrary, seems to be an affection of the cutis vera only, whose papulae are either enlarged, or tumours of a different nature are formed on it, which press outwards on the cuticle, and occasion scaly indurations on the surface.

The first appearance of leprosy is discovered by reddish shining elevations on the skin, often on those parts where the bone is covered only by the integuments, as the skin, on the outside of the fore arm. A thin white scale is soon formed on the top of these elevations, which quickly flatten, while their bases enlarge. The enlargement of their bases continues; but the separate patches constantly preserve a roundish form, though, when they approach and unite, it is generally elliptical. When the scales either fall off by the rubbing of the linen, or are separated by violence, they are soon reproduced; but the surface below appears red and wrinkled, though the rugae do not resemble those of the cuticle, nor are they continuations of the furrows in the contiguous sound surface. Lepra does not appear to be peculiarly the disease of the hairy scalp, though we have generally found traces of it in this part of the body, when it has before appeared on the surface. At the edge of the hair on the forehead it often first attacks, though more frequently the leg, just below the knee, or the fore arm, rising gradually to the trunk. The stiffness of the skin is troublesome, and the itching, which is extremely distressing in hot climates, is, even in these, troublesome while the patient is warm in bed; but the general health seems in no respect affected, and nature, without assistance, will not relieve. The signs of amendment are the diminution of the ridge round the patch, the scales not reproduced when rubbed off, and the appearance of a red more natural cuticle in the centre. All the patches at the same time begin to assume a more healthy look.

The lepra is said to be hereditary. We own that we have not found it so; but Dr. Willan thinks a predisposition to it may be transmitted from parents. In more than one family where there was this tendency, those in whom it appeared on the surface, and who were relieved by medicine, lived long afterwards in a healthy state, while those in whom it did not appear, died young, apparently consumptive. In a constitution of this kind we once observed the phthisis from calculus. The diseases, however, in these cases, were not, perhaps, strictly leprous, though nearly resembling it. In one instance mania supervened on the disappearance of a true leprosy.

Dr. Willan thinks that a slow pulse, or a languid circulation, with what may be expected to attend them, a deficiency of perspiration, constitutes a fundamental part of the predisposition. We cannot say that we have seen the disease most frequently in such constitutions, nor does our recollection furnish any particular habits in which it has appeared most frequent. An indulgence in spirituous liquors has appeared a remote cause; but we have not seen any peculiar diet contribute to it. Those who work among dry powders are said to be subject to it; but we have only seen what resembles it in those who follow one occupation of this kind, viz. millers. Wheat, when ground, rapidly absorbs moisture, and every part of a miller's house is dry. The hands of the labourers are consequently often chopped, sometimes covered with eruptions; but the disease seemingly differs from true lepra. Bricklayers' labourers suffer from lime, and laboratory men from acids; in neither, however, is this disease peculiarly prevalent.

Lepra is a complaint of singular obstinacy, and often resists the best concerted plans. As it appears not to be influenced by diet or situation, and not to be hereditary, it may seem to be merely local; and the ancient physicians, after bleeding and purging, applied the most acrid substances from the animal, vegetable, and mineral kingdom, to cure it. These undoubtedly remove the scales, but they are soon reproduced; for the cause is beyond the reach of applications to the surface only. When internal medicines have in part removed the cause, liniments of tar, sometimes with sulphur, at others with kali, or alum, are often useful. The warm bath is a pleasant and salutary application, whose effects extend beyond the surface; but which also relax the hardened scales, and immediately remove part of the inconvenience, the stiffness. The sulphur waters of Har-rowgate and Moffat combine both views, and are highly useful. The Harrowgate water may be easily imitated for this purpose by uniting the hepar sulphuris with sea salt.

The bath waters combine the good effects of a warm bath with an internal medicine which excites the action of the extreme vessels, an object of considerable importance in the cure of lepra. The minutes of the Bath hospital, on this subject, published by Dr. Falconer, give a very favourable prospect of its advantages. Sea water, used as a bath, both warm and cold, has been equally useful, especially if, like the Bath waters, it is taken internally. Other external preparations have been chiefly mercurial, as a solution of the hydrargyrus muriatus, and the unguentum, hydrargyri nitrati of the London Dispensatory. Dr. Willan does not think these applications preferable to the tar ointment.