Thompson , Leslie Melville

2019-02-15T14:24:40Z

2019-02-15T14:24:40Z

1945

I have dealt with the theories concerning the transmission of leprosy; and have referred briefly to its history and distribution. I have then shown the distinguishing characteristics of the lepra bacillus and of the tubercle bacillus which closely resemble one another, and must be differentiated. The pathological processes have been described, and the types of leprosy which arise from them. The uncertainty as to the length of the "incubation period" has been pointed out. There is considerable evidence in favour of a period of two to three years, but authentic cases have been described in the literature by different writers with incubation periods of seven years and even of twenty-five years. The resulting danger arising from undiagnosed infectious cases of leprosy has been emphasised. Attention has been drawn to the word 'macule' as used in leprology, which is entirely different in significance from its use by dermatologists. The characteristic lesions of the neural type and of the lepromatous type of leprosy have been discussed in detail; and the need for skill and experience on the part cf the physician, in accurately diagnosing early cases of the latter type, has been considered to be of primary importance. Various tests have been described which are of value as aids to diagnosis and prognosis. The importance of a series of estimations of the blood sedimentation rate as a guide to treatment is believed to be essential, and is also of importance in recording the patient's resistance. The fact, that the Wassermann and Kahn standar reactions may be positive in advanced cases of leprosy not associated with syphilis, has been pointed out; and a brief reference has been made to the undoubted value of the Kline reaction in differentiating such cases. It must be noted that prodromal symptoms of headache, malaise, pyrexia, may be present for weeks or months before clinical signs appear; the patient may not consult a doctor, and may go for a long period unrecognised as a case of leprosy. The factors which stand in the way of early diagnosis have been carefully enumerated. Stress has been laid on the three important signs viz. - 1. Anaesthesia to light touch. 2. Thickening of nerves. 3. The finding of leprae bacilli. without any one of which no case should be diagnose as leprosy. The methods of examination for leprae bacilli in skin and mucous membrane have been described in detail. The differential diagnosis has been discussed under three headings, 1. Lesions of the skin resembling leprosy. 2. Lesions producing loss of cutaneous sensibility. 3. Lesions causing deformities and ulcers. The factors influencing prognosis have been weighed with care, emphasis being laid on the poor resistance to leprosy of the tissues of children, and of all malnourished persons. It is most important to realise that there is so far no specific drug against leprosy, -- the ideal drug being one which satisfies the following points, 1. It must rapidly control and eliminate the disease. 2. It must be cheap. 3. It must cause little discomfort when given by injection. An account has been given of the Ghaulmoogral and Hydnocarpus group of drugs, and it has been shown that some leprologists have complete confidence in their efficacy, while other workers consider their action to be without value. A survey has been made of the treatment of leprosy as carried out by myself during the years 1924 -1942, and it is my considered opinion that these oils are of immense value if a preliminary treatment of liver extract has been given before- hand to raise the patient's cellular defensive mechanism to the highest level, as I have found that otherwise these oils have a most depressing effect. The present position of the sulphonamides, especially Promin, has been briefly referred to, and it is suggested that Penicillin may be the answer to the quest for an ideal drug against leprosy. The disastrous results which frequently follow the administration of potassium iodide to leprous patients hava been described. It has been pointed out that in Malaya the severer form of leprosy is found most frequently in malnourished persons, especially those who exist on a diet of polished rice which is deficient in protein and Vitamin B1. In planning a campaign against leprosy certain outstanding problems require a satisfactory solution. These problems have been discussed at length in the text, and a number of practical suggestions are put forward which are the result of my own experience in the treatment of leprosy since 1924: 1. An intensive propaganda campaign to be launched to raise funds, and to stimulate public and medical interest. 2. The whole control of leprosy in India to be in the hands of clinicians, research workers and administrators who have specialised in leprosy; and it is suggested that leprosy scholarships be endowed for this purpose, so that in time to come an ever increasing army of specialists be raised. 3. The people of India to be educated by every simple and direct means, a. as to the value and the proper cooking of the food the country provides, so that malnutrition may be eradicated, b. to co-operate in the voluntary segregation of all infectious cases of leprosy, c. to expect that children of infectious parents can be safeguarded by early separation. d. to realise that leprosy is not an in- curable disease, especially if treated in the early stages. I feel most strongly that,by patient effort, the present devastating, and prejudiced ignorance of the people of India could be turned into a powerful impetus for guarding the welfare of their own families and thus promoting the health of future generations. 4. To have yearly surveys in each area undertaken by reliable observers. 5. Suggestions have been made that all future leprosy work in India should be under the control of a 'Central Institution', with branch, institutes (which I have named Complete Units) each to control a number of out -patient clinics.. In time, Complete Units with their subsidiary Out - patient Clinics would spread like a network, over the length and breadth of India, so that no district of the land would remain unserved, and no leper would remain unknown nor uncared for. Truly do I believe that this Plan of mine is no more daydream, but one that can help to provide a practical answer to the sorrows of this great country. Our purpose and our courage must remain steadfast - to obliterate the stain of leprosy for ever from the British Empire.

http://hdl.handle.net/1842/34215

The University of Edinburgh

Annexe Thesis Digitisation Project 2019 Block 22

Leprosy: a review, and a plan of campaign for India

Thesis or Dissertation

Doctoral

MD Doctor of Medicine