The Pacific commercial advertiser. [volume] (Honolulu, Hawaiian Islands) 1856-1888, 1865-09-09
PACIFIC
Commercial Advertiser.
LeprOsy.

Leprosy, which in Europe and America had
become we'll nigh an historical disease, Is again
beginning to show itself in various localities in
the old and new worlds. This fact will justify
Inc IL laying before the public a short account OF
the disease as | have observed 1t III the Island OF
Madagascar. The number Of cases treated in the
dispensary At AntananariyO during the year 1862
was nearly one hundred, and the following ac-
count of the disease IS drawn up from the notes
u the cases actually observed.
Fog the sake Of clearness of description, the
progress of tubercular leprosy may be divided
into three stages or periods,-the first, charac-
t=rized by the appearance OF spots the second,
by tubercie-; and the third, by liberation OF
falling OF of the members. These three stages
may cO-exist simultaneously in different parts OF
the body thus, leprOus spots may be seen on the
trunk, tutercles OH the face, and liberation NAV
be going on ut the e%xtrenities. Spots Of changed
skin, however, invariably precede the tubercles,
and the latter are III turn succeeded by liberation.
Tubercular leprOsy Is singularly uniform in its
symptoms, progress, and termination III different
parts of the world, nor has 1t suffered any mOdi-
tcation whatever since II was first Described by
ATetens. Several varieties indeed have been de-
scribed by authors, ~ LepTa GnasfheSldod, LeVTa
!GuTlcd, and some others but these varieties are
not founded upon any differences OF importance,
but upon the degree III which Il common symptom
is present, which really furnishes no sufficient
ground for establishing them as distinct varieties.
The disease usually begins so insidiOusly that
the patient Is unable TO state the precise period Of
lL5 commencement. Some authors nave UeScTlDcl
1t as beginning with the constitutional symptoms
proper To fever or Inflammation, as hot skin, full
pulse, rigors, and muscular pains.
Judging from the many cases which have come
under my own observation, this must be u mis-
take. Fever may occur in a leprOus subject,-it
may even be an exciting or, speaking more exact
~, determining cause but 1t must not on this
account be supposed that the fever was the begin
ming of the leprOsy. or that there was more than
an accidental cOnnexiOn between the two. Are
taus remarked justly, - the commencement of the
disease gives no great indication OF 1T neither
does IL appear as ii any unusual ailment had
come upon the man. In this way the patients con-
dition il hopeless, because the physician, from
inattention and ignorance of the patients all
ment, does not apply his art to the commence
ment. when the disease is feeble" This could rot
have been said of leprosy, if it began with the
symptoms OF fever or ~ammatiO
The patient probably discovers accidentally a
small patch of his skin presenting a tint different
from the rest of the body. Such spot may be
seated anywhere, very frequently about the back
OF shoulders. The spot of changed skin may be
of any shape but is generally oval or circular,
and varies in size from sixpence to that of the
palm of the hand. At first the change is SO
slight as to be observable only in some reflections
OF the light. The color of these patches is al
most exactly the same in every case, whatever the
original color of the patients skin. In all, the
first change Is 10 a light brassy tint, which, as
the disease advances. becomes more distinct. 1t
Is soon observed that the texture as well as the
color of the skin il affected. 1t becomes cracked,
assures running across the spots in all directions.
The hairs upon the part become yellow and
stunted, and after a time fall off, leaving the hair
bulbs empty, patent, and enlarged The affected
skin acquires n greasy look, as If 1t were glazed
or vanished, and ceases to be perspirable. From
an early period the spots become thickened, but
are not ut FIRST elevated above the surrounding
healthy skin. The thickening depends upon
efFusion into the subcutaneous cellular tissue.
"A tho 1isaasa a1yanpaa rho trina ETn aeovnaS tho
seat of effusion, and Is felt to be slightly elevated
to the touch.
In three or four of the cases which / have noted
the disease seemed to be moro particularly seated
in the CUTS rera, elevating the skin into large,
broad prominences. Sensation Is at first heighten-
ed, slight wandering pains, formication or itch
ing may be felt over the body or in the affected
parts only. After i few months this hyperas-
thesia gives place 10 anesthesia thus it not I'M
frequently happens that one or more of the older
spots are decidedly numb and feelingless, while
there Is excited sensibility in The more recent
ones. 1t has been already remarked that some
describe, as a distinct variety, a Lepra dndfhesi-
ara. but anesthesia ii present more or less i'll
every instance In two eases tins symptom was
present in a very marked degree. In both the
disease had been remarkably slow in hts progress
the tubercles dilatory In showing themselves. In
neither had the malady reached the stage of sup
puratiOn, although the disease had existed IN the
one patient Tor twenty, and iii the other tor twelve
years. 1 feel satisfied, from careful observation,
that anae5thesia Is more decided in the chronic
form of the disease in patients who live II sober,
prudent life, whose habits seeln calculated rather
70 mitigate than accelerate or intensity the mala-
dy. The hair, as | have stated, falls from the
diseased spots. but this is not confined To the
spots alone, although it usually begins there.
The hair of the eyebrows never escapes, and 1
nave noticed that 1t uniformly begins TO fall from
the outer angle inicdrGs. / am not aware that
this singular fact has ever been alluded to by
writers on lcprosy, although it is quite constant
and sufficiently remarkable. The hair of the
axilla and pubes, and the eyelashes fall as the
disease advances, but the hair of the head is nerer
affected. a popular writer on the East, in de-
scribing leprOSy, has spoken of badness as a
symptom of the disease as observed in Syria.
Ii may indeed happen that a leper, like any other
man, may be bald, but it is an error 10 regard the
badness as a symptom of leprOsy. This mistake
IS not uncommon, and arises from the writers
having in their mind the description given by
Moses of u perfectly different disease. Wherever
the hair falls, the hair fOllicles become enlarged
and patent, especially in the face, so as 10 present
one of the most diagnostic signs of the malady.
So characteristic is this of leprosy. either as a
latent diathesis or a developed disease, that l have
never seen Il leper who did not present it more,
L have often been able from this condition of the
hair follicles alone to recognize members of 4
leprous family in whom the disease was yet
latent.
The naked eyebrows become thickened, rugous,
and projecting. hanging over the hairless eyelids.
To render the aspect still more unsightly, the eye
assumes a lurid glare impossible 10 describe. Per-
haps the word fsrrety is the most appropriate
that can be applied to a change which no words
can express.
The second or tubercular stage of lsprosy su-