NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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REPORT OF THE LEPROSY COMMISSION:
diseased parts. The skin must not be broken, and the exuda-
tion must be allowed to dry on, so as to form a crust. After
about twelve days this will fall off, leaving the skin beneath
clear and free from ulceration. It is not advisable to paint
at one time an area greater than that represented by the skin
of the leg or fore-arm. The applications should not be re-
peated at intervals of less than a week.
3. Internal Medicines.
These are perchloride of mercury in doses of one-fifteenth
to one-twentieth of a grain twice a day for adults, and in cases
where mercury is contra-indicated, sodium carbonate, given in
doses of 10 to 20 grains twice a day.
There is no doubt that this was a rational mode of treat-
ment, and one which afforded distinct relief to the patient.
The mistake made was in regarding it as curative. Whatever
merit the treatment possessed lay in the strict regimen which
had to be observed by the patient, and in the attention to
the functions of the skin which was insured by frequent baths
and frictions. The oil of cashew itself merely acts as a caus-
tic, and the same result can be less laboriously obtained in
tuberculated leprosy by free excision of tubercles, as will be
mentioned below.
The influence of the medicines given internally by Dr.
Beauperthuy may fairly be disregarded. According to Dr.
Bakewell a patient taking sodium carbonate progressed quite
as favourably as one taking mercury perchloride.
Internal medication has always been the difficulty in leprosy.
It is not hard to treat the skin complications and even to attain
some measure of success, but so far no drug has been disco-
vered which taken by the mouth will bear the relation to leprosy
which mercury and potassium iodide bear to syphilis. Fresh
crops of tubercles, or anaesthetic patches, soon make their
appearance, and, as was the case at Cumana, the condition of
The Treatment of Leprosy.
335
patients becomes as bad as, or even worse than, it was before
they were treated.
DIPTEROCARPUS TURBINATUS.
The use of this oil in the treatment of leprosy was first
recommended by Surgeon-Major J. Dougall 3 at Port Blair,
Andaman Islands. Two emulsions were made by direction of
Dr. Dougall. The first was to be taken internally and consisted
of three parts of lime water and one part of gurjun oil. The
second emulsion for external use contained equal parts of
gurjun oil and lime water.
The lepers rose every morning at daybreak and bathed,
using dry earth as a detergent, so as to rub off the previous
day's inunction. They afterwards drank half an ounce of the
first emulsion. The second was then rubbed in for two hours.
At 3 P.M. the same dose was given, and another two hours'
friction practised.
Dr. Dougall tried the effect of this treatment on twenty-
five lepers for a period of six months and says 4 : " The time
has been long enough to show that leprosy, both tubercular
and anaesthetic, can not only be arrested, but the condition of
the lepers can be greatly ameliorated ; and men here who have
not for years been able to do more than drag out a miserable
helpless existence are now able and willing to work, and every
sore is quite healed."
This report was sufficiently encouraging to justify investi-
gations into the gurjun oil treatment of leprosy. The Madras
Government in the course of the next year published an ac-
count of the results obtained with gurjun oil in the hospitals
and asylums of that Presidency. Surgeon-General E. G.
( 3 ) Surgeon-Major J. Dougall, M.D. Report on the Treatment of Leprosy
with Gurjun oil. Calcutta, 1875 ; page 6.
( 4 ) Op. cit., page 14.
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REPORT OF THE LEPROSY COMMISSION :
Balfour, in his covering letter, arranges the medical reports
in three groups 5 —
(1) Those of officers in charge of the three Leper
Hospitals.—In these reports the opinion is ex-
pressed that the oil does not possess any particular
efficacy ;
(2) Those of officers in charge of Civil Dispensaries and
Gaols.—These on the whole are favourable, and
several cases of improvement are reported ;
(3) Those of Regimental Medical Officers.—The cases
under this head are necessarily few, as declared
leprosy is considered to unfit the subject for further
service and he is discharged. Gurjun oil is reported
to be useful in alleviating the more prominent symp-
toms of leprosy, and one case is said to have been
cured.
On the whole, Dr. Balfour considers the results of the trial
of gurjun oil to be encouraging, but points out that in the
supposed cases of cure it will be necessary to watch the future
medical history of the patient.
In Dr. Watt's Dictionary 6 a summary is given of answers
received from nineteen medical men in India who were specially
questioned as to the utility of gurjun oil in leprosy. Of these
answers thirteen were positive, three negative, and three
neutral.
Answers were received by the Commission from a large
number of stations in which gurjun oil had been used for
leprosy. Many of these answers reported that more or less
relief had been obtained, but in no instance was there any
allusion to a cure. In some cases the relief afforded was very
slight. From other stations the answers stated that no effect
( 5 ) Report on the Treatment of Leprosy with Gurjun oil and other Remedies
in Hospitals of the Madras Presidency. Madras, 1876: page ix.
( 6 ) Op. cit., Vol. III, page 169.
The Treatment of Leprosy.
337
whatever had been observed. Some answers were neutral, the
patients having disappeared from observation, or the time during
which they had been under treatment having been too short to
draw conclusions as to the efficacy of the oil.
Dr. Hillis, who tried this treatment in the Mahaica Leper
Asylum, says 7 : " I can claim for gurjun oil that, given a suit-
able case, the disease can be arrested by it, and that in a few
instances there has been no return of the disease for over two
years, but it may nevertheless be premature to say a cure has
taken place."
This experience was not borne out in the Trinidad Asylum, 8
where a trial of the oil showed only such temporary relief as
would follow frictions with cocoanut oil or any other simple
application.
Dr. Vandyke Carter 9 also failed to find that gurjun oil
exerted any specific effect on the course of leprosy. He
used the drug internally and externally in selected cases for
months, without obtaining any perceptible improvement.
From the above review of the various trials which have
been made with gurjun oil, it appears that though a certain
amount of temporary relief may follow its use, it is very
doubtful whether this is more than can be obtained with any
common oil. Dr Dougall's success at Port Blair was probably
due to the fact that he was dealing with a colony of convict
lepers under prison discipline, and was, therefore, able to
carry out his plan of treatment far more rigorously than in
an asylum where, as a rule, patients are averse to any thera-
peutic measures which involve the least exertion. It is quite
possible that the prolonged frictions with dry earth, and the
regular sea-bathing, were quite as potent in affording relief as
the use of the gurjun oil.
( 7 ) Leprosy in British Guiana, page 224.
( 8 ) Report on the Trinidad Leper Asylum for 1884.
( 9 ) Reports on Leprosy, Second Series, 1876, page 36.
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REPORT OF THE LEPROSY COMMISSION :
GYNOCARDIA ODORATA.
This oil has long been known in the East as a remedy
for leprosy, but it is only of late years that it has attracted
notice in Europe. Like gurjun oil it is used both internally
and externally.
Of eight answers recorded by Dr. Watt 10 from medical
men who had used chaulmoogra oil in leprosy, four were
favourable, two denied that any result was obtained, while two
were neutral and expressed no opinion as to the value of the oil.
Dr. Vandyke Carter 11 selected cases for treatment with
chaulmoogra oil and arranged them under as follows :—
(a) Young fairly nourished subjects with early disease.
In them the result was decidedly beneficial.
(b) Confirmed, but not disabled lepers. The effect of
the oil on these was moderately beneficial.
(c) Confirmed, disabled, or broken-down subjects. No
result was obtained in these patients.
Dr. Carter goes on to say that the longer the oil is used,
the more favourable will the result be, both in degree and
permanence. The good effect may last for three, four, or
five years after prolonged use of the oil, but the disease is
never eradicated even in the most suitable cases.
Of the first forty-seven answers received by the Commis-
sion from asylums and stations in which chaulmoogra oil had
been used, thirty reported more or less relief after the use of
the oil. In some the relief was very slight, while in others
the disease was said to be arrested, In no case was a cure
reported. From twelve stations the reports showed that there
was no effect after chaulmoogra treatment, while five answers
did not express an opinion one way or the other.
( 10 ) Op. cit., Vol. IV, page 1:94.
( 11 ) Op, cit., page 34.
The Treatment of Leprosy.
339
Mr. Sakharam Arjun, 12 who was in charge of the ward for
incurables in the Jamsetjee Jeejeebhoy Hospital, Bombay, gives
his opinion of the value of chaulmoogra oil as follows :—
" Under the prolonged and continuous use of this oil the
progress of the disease is arrested, the skin becomes soft and
supple, the discolorations vanish, the different morbid sensa-
tions leave the patient, the mental hebetude passes away, the
impaired sensibility is completely or partially restored, the
ulcers heal and cicatrise though ever prone to break out again,
and the general nutrition of the tissues improves, patients
crippled before being known to walk about unassisted and to
gain in strength and weight."
In the Trinidad Leper Asylum 13 many of the more intelli-
gent patients asked for chaulmoogra oil of their own accord
and continued its use for several months.
One man used the oil internally and externally for seven
years. The tubercles disappeared from his face and extre-
mities and the anaesthesia was lessened.
The fact that these lepers persevered in any plan of treat-
ment is in itself strong presumptive evidence that they derived
some benefit from the drug employed, for, as was pointed
out earlier in this chapter, such patients soon tire of any
systematic medication.
The chief results obtained in eighteen cases were—
1. Increase of perspiration.
2. Decrease of tubercles.
3. Improved appetite and sense of well-being.
4. Increase of sensation.
5. Increased suppleness of skin and lessening of
pains in joints.
A similar result was observed in a highly intelligent private
patient who had taken chaulmoogra capsules for six years,
and who had also tried residence in Europe. At one time he
( 12 ) Report on Leprosy, 1873.
( 13 ) Report on Trinidad Leper Asylum for 1889, pages 11 and 12.
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REPORT OF THE LEPROSY COMMISSION:
took seventy-five drops of the oil a day. When last seen
the face was clear, but there were one or two nodules in the
lobes of the ears, and a few small reddish patches on the
thighs. The intervals between the tubercular outbreaks were
much greater, and the patient was able to do a great deal of
riding.
From the above experiences derived from various sources it
seems that the action of chaulmoogra oil in leprosy, though at
the best palliative, is nevertheless more marked than that of
gurjun oil. Indeed it is probable that a prolonged and regular
use of this oil may in some cases arrest the progress of the
disease, though for how long must still be doubtful.
HYDNOCARPUS WIGHTIANA.
This oil was employed together with chaulmoogra oil in the
treatment originated by the late Mr. Bhao Daji, which attained
such notoriety in Bombay about twenty years ago. Apparently
the first results obtained were encouraging, but Dr. Vandyke
Carter, 14 who was living in Bombay at the time, and who had,
therefore, ample opportunities of observing the effect of this
treatment, writes as follows :—" I have before me notes of three
or four cases which were duly treated here, and in none has
a cure been effected, for either no good whatever resulted, or
the symptoms are simply quiescent." Dr. Carter, however,
considers that kowti oil is a useful aid in the treatment of
leprosy.
The most noteworthy oils used in the treatment of leprosy
have now been discussed. From what has been said above it
will be evident that any oil which is thoroughly rubbed into the
skin may afford more or less relief. Hence it will not be neces-
sary to discuss the other seven oils mentioned at the beginning
of this section, for no specific action can be claimed for any of
them.
( 14 ) Reports on Leprosy, Second Series, 1876, page 36.
The Treatment of Leprosy.
341
Two common Indian plants, which have attained a consi-
derable reputation in the treatment of leprosy, may here be
mentioned. They are the Madar (Calotropis gigantea) and
the Asiatic Pennywort (Hydrocotyle Asiatica). From evi-
dence collected, however, it appears that their value has been
overstated. 15 The first is said to be temporarily useful as a
tonic in recent cases of leprosy, while the stimulant effects of
the second on the circulation are most marked in the pre-
liminary anaesthetic stages of the disease. These drugs have
clearly no specific action in leprosy.
Arsenic is a drug which has been largely used in the treat-
ment of leprosy, and sometimes with good result. Dr. Bower-
bank 16 writing from Jamaica says : "In only one case did medi-
cal treatment seem to keep the disease in check. During
eighteen or twenty years the patient, a female, had repeated
attacks of apparently intermittent fever, and on each occasion
the characteristic spots made their appearance ; she had also
anaesthesia and slight enlargement of the eyebrows and lobules
of the ears. The use of Fowler's solution always checked the
disease. "
Dr. W. Nicholson 17 of Antigua also remarks : " Arsenic is
the only remedy which in my practice has had any effect in
arresting the disease, and that only for a time. I have seen
the tubercles disappear under its use, sensation restored to
fingers that were incapable of feeling and using a needle, so
that the patient was enabled to sew, yet the disease returned
and proved fatal. "
In the Trinidad Asylum 18 arsenic was given during several
months to two lepers who were particularly subject to frequent
acute outbreaks of tubercles. One of these patients was
( 15 ) Dictionary of the Economic Products of India, by Dr. G. Watt, Vol. II,
page 45, Vol. IV, page 313.
( 16 ) Report on Leprosy by the Royal College of Physicians, 1867, page 14.
( 17 ) Op. cit., page 21.
( 18 ) Report on Trinidad Leper Asylum, 1884.
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REPORT OF THE LEPROSY COMMISSION :
German, the other a slightly coloured Barbadian. Both had
very delicate skins, and the result observed after prolonged
treatment with liquor arsenicalis was a very marked diminution
in the frequency of the tubercular eruptions. The German, in
fact, was free from an attack for about a year, whereas before
he began taking arsenic the exacerbations had occurred at
intervals of a few weeks.
The use of ichthyol and resorcin in the treatment of leprosy
was recommended by Dr. Unna of Hamburg in 1886. Since
that time they have been used in various parts of the world,
but the results obtained have hardly fulfilled expectations. It
is true that many of the cutaneous complications of leprosy
may be relieved or removed by the use of these drugs, but the
same result can be obtained with a simple application such as
vaseline. Ichthyol and resorcin have lately been issued by the
Government for trial in the various Indian stations. Reference
to the table at the end of this chapter will show that little
effect has followed their use in leprosy.
Still more recently Dr. Lutz in Hawaii has brought to notice
a new group of drugs for the treatment of leprosy. In a report,
dated June 30th, 1890, he says : " In general we have had no
instance of the disease making progress in patients treated by
the most efficacious means, that is, salol and salicylate of soda
internally, and chrysarobin and pyrogallic acid externally. "
Some members of the Commission tested the action of salol
on two lepers in Simla who happened to present themselves for
treatment, but observed no result. Surgeon-Major H. D. Cook
kindly treated a number of patients in the Madras Leper Asy-
lum with salol, and his report is appended.
From an ambulatory treatment little or nothing could be ex-
pected, as this naturally excludes all clinical observation. Dr.
Cook's verdict confirms the opinion of Dr. Lutz, that as a
palliative, salol is of decided value in leprosy. The results,
even after a course of five weeks, are so promising that the
treatment is being continued at the Madras Asylum. No doubt,
The Treatment of Leprosy.
343
prolonged and critical observation is necessary before a decid-
ed opinion can be given ; and this Dr. Cook has fully realised.
There can, however, be no question as to the temporary benefit
derived from the salol treatment. Doses of twenty grains were
given three times a day for two weeks, and then increased to
thirty grains three times a day. Apparently large doses must
be given for a long time. Most of the cases subjected to the
treatment suffered from tubercular or mixed leprosy. The
greatest testimony in favour of the drug is, that the patients
professed to feel better and gladly persisted in the treatment,
while the native as a rule is easily disheartened and will not
subject himself to therapeutic measures which after a short
trial give him no relief. Bad effects were hardly ever observed,
even after large doses of salol. On the other hand, tubercles
seem to decrease in size, ulcerate, and then subside or heal up :
a fresh crop of tubercles follows and goes through the same
phases. Sensation was often restored, and anaesthetic areas,
in fact, at times became hyperæsthetic ; patches improved in
colour, and the scaly, shiny appearance of the skin which is so
characteristic of certain forms of leprosy, assumed a healthier
look, and the skin became moist and more sensitive. The
general condition of the patient often improved greatly.
With such favourable results after so short a period, it is
justifiable to persevere. Accordingly Dr, Cook is continuing
the treatment, and thus better means will be given to fully
estimate the value of salol. If future experience confirms these
early observations, then Dr. Lutz has indeed found in salol a
valuable drug for the palliative treatment of leprosy.
A brief allusion only need be made to such drugs as per-
chloride of iron, potassium iodide, and cod-liver oil. These
are often very useful adjuncts in the treatment of leprosy, but
their action is exactly the same as in other diseases. Mercury
may be used when the leper is suffering from syphilis. The
latter disease will be rapidly brought under control, while the
leprosy remains uninfluenced. The risk of giving mercury in
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REPORT OF THE LEPROSY COMMISSION :
leprosy, which some writers have insisted on, appears to be
overrated. There is no doubt that with ordinary care this
drug may be as freely given in leprosy as in any other disease.
From the above evidence it would appear that chaulmoogra
oil and arsenic are the most valuable drugs at present known
for the palliative treatment of leprosy ; and if further experience
and observation justify the hopes expressed by Dr. Cook at the
beginning of his treatment of lepers with salol, then the latter
must rank high among the drugs used and given for the
amelioration of the general and local condition of these patients.
It must, however, always be remembered that spontaneous sub-
sidence of tubercles, or even arrest of the disease, may take
place without any treatment, hence it is always difficult to esti-
mate the part contributed by drugs to any good result which
may follow their use.
Surgical.
Much may be done to relieve the leper by surgical interfer-
ence. It may be stated as a general rule that any operation
which would be undertaken on another patient may be per-
formed on one suffering from leprosy. The rapidity with which
the tissues of lepers heal after operation is remarkable. This
may, perhaps, be due to the excess of fibrin which has been
found in the blood of these patients, a fact which was first
pointed out by Danielssen and Boeck, 19 and which has since
been confirmed by Hillairet 20 and at the Trinidad Asylum. 21
In the last-named institution an examination of the blood of
fifty lepers, tuberculated, anaesthetic, and mixed, showed the
average quantity of fibrin to be .7 per cent.
An operation which has attracted considerable attention as
a means of treatment in leprosy is nerve-stretching. This has
yielded good results as practised by Surgeon-Major Lawrie, 22
( 19 ) Traité de la Spedalskhed. Paris, 1848.
( 20 ) Annales de Dermatologie et Syphilographie.
( 21 ) Report on Trinidad Leper Asylum for 1887.
( 22 ) Lancet, 1881.
The Treatment of Leprosy.
345
and by Drs. Dowries, 23 Neve, 24 Mitra, 25 and others in India.
In Trinidad 26 out of one hundred cases operated on, more or
less relief was obtained in about half. The chief results noticed
were relief of pain in the course of the nerves operated on,
healing of perforating ulcers in the area supplied by these
nerves, and, more rarely, some decrease of anaesthesia. Unfor-
tunately none of these effects were permanent, and the opera-
tion had sometimes to be repeated on the same nerve. There
is no doubt, however, that nerve-stretching is a valuable aid,
especially in the treatment of the distressing neuralgia which
often complicates leprosy.
But the operation cannot be
claimed as in any way curative.
Free excision of cutaneous tubercles is a procedure which
is followed for a time by good results, and if a drug could
be found which given internally would prevent recurrence of
these growths, there would be a fair hope of ultimate suc-
cess.
By cutting deeply it is possible to eradicate single tuber-
cles or circumscribed masses of tubercle and to obtain a
clean cicatrix, but after a few weeks or months the growths
begin to recur in the sound skin around these cicatrices,
and the patient relapses as rapidly as after the Beauperthuy
treatment.
Much pain is often experienced in perforating ulcers and
in sinuses leading to dead bone, especially by patients who
are other wise anaesthetic. Free incision down to the bone
gives great relief in these cases. The effect of this treatment
is appreciated by the patients, who eagerly beg to be operated
on. There is also no doubt that early incision in such cases
does much to prevent the gangrene which is so common in
leprosy. When this gangrene has actually set in, amputa-
( 23 ) Lancet, 1886.
( 24 ) Edinburgh Medical Journal, 1884-85.
( 25 ) Indian Medical Gazette, 1888.
( 26 ) British Medical Journal, 1888.