( 4 )
No. 352, dated Soory, the 22nd June 1877.
Prom—A. EmGiBBON, Esq., Offg. Civil Medical Officer.
To—The Deputy Surgeon General, Presidency Circle.
IN compliance with your circular memorandum No. Ill, dated the 5th January
last, I have the honour to submit the following remarks on leprosy, viz., that it
is not confined to any particular locality, but is to be found more or less in all
parts of the district. There are in all about 2,872 persons of both sexes affected
with this disease as will be seen by the table inserted below :
Names of thannahs.
Burwan
Bhulpur
Doobrajpur
Labpur
Mouressur
Rajnuggur
Sacoolipur
Soory
.
.
.
m
•
.
•
...
...
. . .
...
. . .
. . .
...
Total
Male lepers.
147
412
628
209
382
126
J22
374
2,410
Female lepers.
19
81
126
30
78
23
23
82
462
Total.
166
493
754
239
460
149
145
456
2,872
There are three forms of leprosy recognized in this district, viz., (a) tuber-
cular, (b) ansesthetic, (e) vesiculating variety :
(a)—This form of leprosy commences with thickening lividity and loss of
sensation in the skin of some part of the face or extremities.
The cheeks
and ears and nose are most often the seats of it, but other parts do not escape. As
the disease advances, the face becomes swollen, ears lobulated, nose depressed and
flattened from necrosis of the nasal septum, the hairs on the upper lip and chin
and eyebrows fall off. In a still more advanced stage the skin of parts of the face,
trunk and extremities is often covered with small tubercles collected in groups, and
not unfrequently superficial ulcers are seen upon the ears and extremities. Enlarge-
ment of the lymphatic glands is not uncommon. Fissures and ulceration occur
in the knuckles at the heels or on the soles of the feet, and loss of parts takes
place by sloughing and necrosis commencing at the joints, rather than by interstitial
absorption ; but both processes may go on simultaneously. The sufferer at last
sinks from exhaustion, or is destroyed by a bowel affection.
(b)—This variety is usually noticed at the commencement with impairment
of the tactile senses, with inability to appreciate difference of temperature, and
other kinds of irritation in the face, ears and extremities, which is followed by the
appearance of one or more patches of discolouration of the skin on any part of the
body. These patches are lighter in colour than the surrounding skin, and attended
with loss of sensation. This, the early stage of the disease, may continue for a
variable period ; but it is sooner or later followed by atrophy or wasting and inters-
titial absorption of the deeper-seated tissues. The hands and feet become distorted
and altered in shape, and not unfrequently numerous small bulloe form, especially
at the extremities of the toes and fingers ; these burst and re-appear, and sometimes
lead to the formation of ulcers. An ulcer on the sole of the foot is often traced
to a bulloe j the interstitial absorption, as already mentioned, commences at the end
of the fingers and toes, and phalanx after phalanx is destroyed. In the progress
of the disease extensive sloughing ulcers, which often clean and heal, are apt to
form. Along with the local changes just noticed there is more or less cachexia,
and, indeed, a cachetic state often precedes the local manifestation of the disease.
In the more advanced stages there is much emaciation, muscular power is impaired,
the organs of special sense are blunted, ulcers of all sizes and in various conditions
are seen upon the body and limbs, the hairs fall off, irregular accession of fever