Tubercular leprosy in Madagascar / by Andrew Davidson.

  • Davidson, Andrew, 1836-1918.
Date:
1864
Catalogue details

Licence: Public Domain Mark

Credit: Tubercular leprosy in Madagascar / by Andrew Davidson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    subject;—-it may even be an exciting or, speaking more exactly, determining cause; but it must not on this account be supposed that the fever was the beginning of the leprosy, or that there was more than an accidental connexion between the two. Aretseus remarked justly, the commencement of the disease gives no great indication of it; neither does it appear as if any unusual ailment had come upon the man. ... In this way the patient's condition is hopeless, because the physician, from inattention and ignorance of the patient's ailment, does not apply his art to the commencement, when the disease is feeble. This could not have been said of leprosy, if it began with the symptoms of fever or inflammation. I 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 or I shoulders. The spot of changed skin may be of any shape, but is gen- erally 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 observ- able only in some reflections of the light. The colour of these patches is almost exactly the same in every case, whatever the original colour of the patient's skin. In all, the first change is to a light brassy tint, which, as the disease advances, becomes more distinct. It is soon observed that the texture as well as the colour j of the skin is affected. It becomes cracked, fissures 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 a gi-easy look, as if it were glazed or varnished, and ceases to be perspirable. ^ From an early period the spots become thickened, but are not at j. first elevated above the surrounding healthy skin. This thickening ' depends upon effusion into the subcutaneous cellular tissue. As the disease advances the true skin becomes the seat of effusion, and is felt to be slightly elevated to the touch. In three or four of the cases which I have noted the disease seemed to be more particularly seated in the cutis vera, elevating the skin into large, broad prominences. Sensation is at first heightened, slight wandering pains, formication or itching may be I felt over the body or in the affected parts only. After a few • months this hypersesthesia gives place to anajsthesia; thus it not unfrequently happens that one or more of the older spots are decidedly numb and feelingless, while there is excited sensibility in the more recent ones. It has been already remarked that some t describe, as a distinct variety, a Lepra anaistliesiaca, but anaesthesia is present more or less in every instance. In two cases this syni])tom was present in a very marked degree. In both the disease had been remarkably slow in its progress; the tubercles dilatory in showing \ themselves. In neither had the malady reached the stage of suppuration, although the disease had existed in the one patient