Saturday press. [volume] (Honolulu, H.I.) 1880-1885, 1883-05-12
sypHTIfs tND LEPRosr.


Mathes for the Advertiser A portion Of !,
was put in type, and was then refused inser-
lion.
As recently the article Of Doctor Fitch has
been so ably answered by Mr.. A. c. smith,
will pass many Of the minor point at issue and
devote myself more particularly to proving the
separability Of leprosy and syphilis,
The public Of Honolulu must feel as though
to digest any more matter on the hackneyed
subject Of leprosy is asking 4 great deal but
my excuse is, that to stand by and see the pub.
lie misled by such an article as "Leprosy from
the standpoint Of Dr. Fitch, in which IS dis.
played such bewildering confusion of the dis
tinctive features of syphilis and leprosy, is inn
possible; and therefore venture to champion
the cause Of truth and science, and present in
as succinct form as possible those main differ.
ences established by modern investigations.
might premise my remarks with the state.
ment that all modem dermatologists draw a
wide line OF demarkation between leprosy and
syphilis. AT one time the difference between
the two diseases was not so apparent but that
was when the knowledge Of skin diseases was
very crude when such diseases as scarlet fever
and measles were considered one and the
same; when lupus, syphilis, psoriasis and &c
zema were but vaguely separated. But long
since the identity Of each Of these as separate
affections, as well as that Of leprosy, has been
acknowledged. To DanielSson and Boeck
Nandyke Carter, Hebra, Kaposi, and others,
we are indebted for an accurate knowledge OF
the clinical history Of lcprosy and through the
mlcroscope-the sine 9hd non OF modern med.
ical inyestigation-in the hands of the ilustri
Gus Nirchoow, we have been made cognizant
of its pathology.
The tenor OF Doctor Fitch's article is an al.
tempt to establish two things. FRS,
identity of syphilis and leprosy, or rather an
assertion that eprosy is but late stage o
syphilis and, second, the non contagious
character of leprosy. The article pretcnds to
say that at certain stages there is great diff
Guilty in distinguishing between the two diseases.
Given a clear case Of leprosy, and clear case o
syphilis, | know of no two skin affections in
which the difierential diagnosis can be made
with such certainty and should there be the
least shadow of doubt, proper nt.syphili
tic treatment appropriate to the stage in which
the case might be, would decide matters inside
of thirty days. II leprosy, but an Indifferent
change will be shown, while If it be syphilis,
almost every vestige Of the symptoms will have
disappeared. Unfortunately, cases occur in
these islands where both leprosy and syphilis
are present, and the mingling of the two at the
same time may cause confusion.
In speaking Of the similarity of the two dis.
eases, Doctor Fitch remarks "There are the
same coppcr-colored sores, thick crusted with
scabs; the same aching bones; the same
swollen glands; the same pigment patches the
same intense feeling of GOODNESS (1) and the
same necrosis or death of portion of bone. v
These symptoms, taken separately, are presen,
in vast number of skin affections grouped
together, they are found in several, and are
distinctive of none. What stamps the entity
OF any morbid process (disease), is a coherent
recognition of the symptoms in their entirety.
1t might equally well be said of measles and
scarlet fever, because, in both there is soreness
of the fauces, in both there is fever; in both a
macular eruption, followed by papular stage,
and then stage OF desiccation, that they must
necessarily be the same. But it is proper
recognition Of the period of incubation, of the
severity OF the throat symptoms, the time OF
appearance of the eruption, the parts where il
hrst appears, the difference of the desiccating
scales, and the hight OF the temperature which
are, to all but the eyes of tyro, unmistakabe
evidences OF the individuality of each AL
though these two diseases have so much in
common, they are separate and distinct; each
induced by its own peculiar germ. Not only
'h' SiishaNlSi vi NyllDlOHlS, Dul tlIllt
required for each to develop, as well as the
order Of their sequence, must be taken into
consideration. So much so is this the case
that at one time the writer saw in the grea,
h,ankfn-hanS, at Vienna, three of the mos,
skiilful dermatologists of modern times, Hebra,
Neumann, and kaposi, each make a separate
diagnosis in certain case in which they used
inspection alone, and without asking the pa.
iient question. BY one il was called penn.
phigus, by another urticaria bullosa, and by q
third herpes iris But, after questioning the
patient, and comparing the time of develop
ment OF the symptoms, ETC., all agreed that il
could only be urticaria bullosa. Such exam
pies could be multiplied ad infnifnm.
But let us analyze the symptoms above re-
ferred to. Copper.colored " spots are pres
ent in any form of skin disease, where the con
gestion is intense and of long standing, and
where the turgid capillary circulation is at,
tended with more or less stasis allowing Q
breaking up of some red blood corpuscles
and deposit of the red coloring matter of the
blood in the shape Of a coppery-hued pigment
The copper.color in the spots Of leprosy i.
more marked than it ever is in syphilis.
Aching bones" occur in all diseases in
which the system is loaded with specific
poison. The symptom is present as pro
''ch'cus VI VI t1G dCutc INFECTIOUS ulS
eases, and among chronic disorders il is Just as
characteristic of lencocythemia, or chronic
malarial poisoning, as it is Of syphilis ol
leprosy.
"Swollen glands" follow any case of blood.
poisoning; it only requires the Emphatic cir
culation to become the receptacle of morbid
product, and enlargement Of the glands ensues
as result OF the irritation. Enlarged glands
are present in tuberculosis (scrofulosis), in can
Ger, in pyaemia, in lymphadenoma, in many
OF the common form Of skin eruptions, in sy
philis and in leprosy.
Pigment patches are simply the sequel o.
chronic congestion and liberation OF the skin.
1t Is as common after lupitic, eczematous, and
other morbid processes as il is after syphilis
The pigment patches OF leprosy, however
differ from those Of syphilis in partaking of tn,
nature OF melanopathia, disease in which the
black pigment Of the skin increases in patches
Furthermore, the opposite condition to melan
opathia, whitening Of the skin, is not un
commonly present in leprosy, but is never
concomitant of syphilis.
Necrosis" or death OF bone is not pecu
liar to syphilis or leprosy, but more otter
follows tuberculosis; il may also result from
carcinoma, OF osteo-sarcoma. In leprosy il |,
only found on the extremities, being usual,
>>>C'I"''N' y b.hhbiShS VI 'hS noit ~
syphilis, on the other hand, ii may attack an,
bone Of the body, and is known 10 attack
those OF the head more frequently than ,hoss
of the extremities.
! will now briefly point out some Of tn,
differences in the clinical history Of the twe
Diseases In syphilis there is comparativel,
short period Of incubation. it being seldom
longer than -four weeks. In leprosy, the period
oil incubation is very long, ranging probabl,
from two to ten years. In syphilis there are
three distinct stages: the primary stage i
marked at the point OF inoculation by an mi
tial induraied sore, which is always character
istic OF syphilis, and Of syphilis only And nc
writer has ever observed il in relation tc
leprosy Doctor fitch's observations to tn,
contrary, therefore, 90 for nothing, since h,
has not been in the islands long enough tc
watch single case Of leprosy from its incep
ton to lis close in death. According to hi,
Arguments syDhilis mercedes lenrosv ~ eav.,