Leprosy Cases in the British Isles

Abstract

At the request of the MedicaI Committee of the British Empire Leprosy Relief Association a subcommittee consisting of the three of us have carried out an inquiry into the number of leprosy cases seen during the last thirty years by de rni atologists in all parts of the country. The following is an analysis of replies received to a circular letter which enclosed forms ' to cover the required information. These were received from fifty specialists, only fourteen of whom had seen any cases of the disease. The great majority were reported by Dr. ]. M. H. MacLeod (to whom we are particularly indebted for his reports of 'càS�S) from the St. Giles Homes in Essex and private cases, and byi two of us (L.R. and E.M.). All but six cases had been seen i n Londón, dOlibtless due to so many patients from overseas visiting Lond o n for medicaI advice. The provinces therefore show very few cases, althbugh no doubt there are some regarding which n o info rnl ation has been received. i Càncealment is likely to be less ' common than it was two ' decades ago now that it is generaily kno w n •that treatment of value is available to those seeking it in good time. TABLE L-CO' u1titries in wh�ch t!te DiseuS le was Apparently Acquired (87 Cases) Europe: British isles 4. Malta I, Norway I, Russia I ...

Fever as a Mechanism of Resistance

“…Brand, however, has confirmed what others have apparently suspected (126,127), that these areas of palpable enlargement in nerve trunks represent well-localized segmental disease and that the nerve is spared in all but its most superficial course. The distribution of dermal lesions has long been noted to show puzzling variations in different populations of the world (127) and, without going into detail here, it can be stated that trauma can be eliminated as playing a significant part, and that the areas of skin least likely to be uncovered by clothing and hence least likely to be exposed, are invariably least likely to be diseased. Leprous lesions of the eye are notable for their anterior localization; conjunctivitis, keratitis, and iritis predominate and disease of the posterior globe is exceedingly rare, if, indeed, it occurs at all (126)(127)(128)(129).…”

“…The distribution of dermal lesions has long been noted to show puzzling variations in different populations of the world (127) and, without going into detail here, it can be stated that trauma can be eliminated as playing a significant part, and that the areas of skin least likely to be uncovered by clothing and hence least likely to be exposed, are invariably least likely to be diseased. Leprous lesions of the eye are notable for their anterior localization; conjunctivitis, keratitis, and iritis predominate and disease of the posterior globe is exceedingly rare, if, indeed, it occurs at all (126)(127)(128)(129). The frequency with which leprosy involves the nasal mucosa is well known, and late disease of the buccal mucosa, pharynx, larynx, or upper trachea is not unusual.…”

“…Brand has been concerned with surgical correction of orthopedic deformities in arrested leprosy; in hundreds of operations, he has noted that destructive lesions are limited to the most superficial portions of nerves and tendons. The classic physical findings of thickening of certain nerves, the posterior auricular, ulnar at the elbow, superficial peroneal, radial, and median antebrachial (126,127) have usually been looked upon as representing areas in which the result of generalized involvement of a nerve simply happens to be anatomically accessible to palpation. Brand, however, has confirmed what others have apparently suspected (126,127), that these areas of palpable enlargement in nerve trunks represent well-localized segmental disease and that the nerve is spared in all but its most superficial course.…”

“…The classic physical findings of thickening of certain nerves, the posterior auricular, ulnar at the elbow, superficial peroneal, radial, and median antebrachial (126,127) have usually been looked upon as representing areas in which the result of generalized involvement of a nerve simply happens to be anatomically accessible to palpation. Brand, however, has confirmed what others have apparently suspected (126,127), that these areas of palpable enlargement in nerve trunks represent well-localized segmental disease and that the nerve is spared in all but its most superficial course. The distribution of dermal lesions has long been noted to show puzzling variations in different populations of the world (127) and, without going into detail here, it can be stated that trauma can be eliminated as playing a significant part, and that the areas of skin least likely to be uncovered by clothing and hence least likely to be exposed, are invariably least likely to be diseased.…”

Genitourinary Leprosy

“…Trauma [21] and low temperature [2] have been implicated. The obliterative endarteritis suggests an immediate-type hypersensitivity reac tion with a secondary ischemic component.…”