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29
adults in areas in which leprosy occurs appear to be immune, but
children are very susceptible. The disease has almost disappeared from
most temperate countries, but it is still common in Asia, Africa, and
Central and South America. At least 2,000,000 people are known to
have the disease, and the actual number of infected people may be as
high as 15,000,000. In sheer numbers, leprosy presents a serious
problem, not lessened by the fact that it is a disabling, deforming dis-
ease, slowly progressing throughout the life of the leper but not usually
cutting that life short. Management of leprosy involves social,
vocational, medical, rehabilitative, orthopaedic, and reconstructive
surgical services.
The disease is caused by the leprosy (or Hansen) bacillus,
Mycobacterium leprae, and has two principal forms, the tuberculoid
and the lepromatous. How the bacillus gets into the human body is not
clearly known. It can be discharged in enormous quantities from the
nose or broken-down sores of an infected person and, therefore, can be
inhaled or spread from skin to skin. It seems that prolonged, close
physical contact with an infected person usually (but not invariably)
precedes active infection in those who are susceptible. Congenital
leprosy is unknown; infants born of infected parents do not develop the
disorder if separated from them at birth
The human body's first reaction to the leprosy bacillus takes place
in the deep layers of the skin. The intense cellular reaction involves all
of the thicknesses of the skin and the tissues under it, the sweat glands,
the hair follicles, and the nerve fibrils that end in the skin. All of this
shows up on the infected person's skin as a firm dry spot in which there
is no sense of heat, cold, or touch. The cellular reaction continues to
spread into the main trunk of the involved nerve, tending to strangle it
so that impulses cannot get up or down and thereby causing loss of
30
power in the muscles of the area, loss of sense of pain, and loss of cir-
culation in the affected part. This is most commonly seen in the forearm
or lower leg, and it leads to claw hand and gross deformity of the foot,
but paralysis of muscles of the face, eye, and neck may also occur. The
patient is unable to feel pain and minor injuries pass unnoticed. Large
eroding ulcers can form, causing loss of fingers and toes; sometimes the
condition of the limb is so bad that amputation is necessary.
The progress of leprosy is slow. It may be years before a child in-
fected by a parent shows the first sign of the disease, often a vague,
scarcely noticed spot on the skin. Years may pass before any change is
noticed, and the child has often grown to an adult before the disease is
recognized. Lepers suffer occasionally from bouts of fever, but the
course of the disease is mainly one of increasing disability and
disfiguration. Lepers often do not die of leprosy; they can live a normal
span of years and, with proper medical and rehabilitative care, can live
in some measure of comfort.
Apart from the use of drugs, the management of the disease is a
vast human problem. The leper must be helped in his disfigurement and
his paralysis. The greatest problem is the prevention of infection. A
baby born to a leprous mother has little chance of escape unless it is
separated from her. A father is almost bound to infect some members of
his family unless taken away from them. The fear of separation makes
the family conceal the disease and thus increases the danger of its
spread. The ideal must be not a colony for lepers but village or
community groups in which whole families can live in good conditions
and the leper can be given necessary treatment and the encouragement
and help to work within the disease's limitations.
adults in areas in which leprosy occurs appear to be immune, but power in the muscles of the area, loss of sense of pain, and loss of cir-
children are very susceptible. The disease has almost disappeared from culation in the affected part. This is most commonly seen in the forearm
most temperate countries, but it is still common in Asia, Africa, and or lower leg, and it leads to claw hand and gross deformity of the foot,
Central and South America. At least 2,000,000 people are known to but paralysis of muscles of the face, eye, and neck may also occur. The
have the disease, and the actual number of infected people may be as patient is unable to feel pain and minor injuries pass unnoticed. Large
high as 15,000,000. In sheer numbers, leprosy presents a serious eroding ulcers can form, causing loss of fingers and toes; sometimes the
problem, not lessened by the fact that it is a disabling, deforming dis- condition of the limb is so bad that amputation is necessary.
ease, slowly progressing throughout the life of the leper but not usually The progress of leprosy is slow. It may be years before a child in-
cutting that life short. Management of leprosy involves social, fected by a parent shows the first sign of the disease, often a vague,
vocational, medical, rehabilitative, orthopaedic, and reconstructive scarcely noticed spot on the skin. Years may pass before any change is
surgical services. noticed, and the child has often grown to an adult before the disease is
The disease is caused by the leprosy (or Hansen) bacillus, recognized. Lepers suffer occasionally from bouts of fever, but the
Mycobacterium leprae, and has two principal forms, the tuberculoid course of the disease is mainly one of increasing disability and
and the lepromatous. How the bacillus gets into the human body is not disfiguration. Lepers often do not die of leprosy; they can live a normal
clearly known. It can be discharged in enormous quantities from the span of years and, with proper medical and rehabilitative care, can live
nose or broken-down sores of an infected person and, therefore, can be in some measure of comfort.
inhaled or spread from skin to skin. It seems that prolonged, close Apart from the use of drugs, the management of the disease is a
physical contact with an infected person usually (but not invariably) vast human problem. The leper must be helped in his disfigurement and
precedes active infection in those who are susceptible. Congenital his paralysis. The greatest problem is the prevention of infection. A
leprosy is unknown; infants born of infected parents do not develop the baby born to a leprous mother has little chance of escape unless it is
disorder if separated from them at birth separated from her. A father is almost bound to infect some members of
The human body's first reaction to the leprosy bacillus takes place his family unless taken away from them. The fear of separation makes
in the deep layers of the skin. The intense cellular reaction involves all the family conceal the disease and thus increases the danger of its
of the thicknesses of the skin and the tissues under it, the sweat glands, spread. The ideal must be not a colony for lepers but village or
the hair follicles, and the nerve fibrils that end in the skin. All of this community groups in which whole families can live in good conditions
shows up on the infected person's skin as a firm dry spot in which there and the leper can be given necessary treatment and the encouragement
is no sense of heat, cold, or touch. The cellular reaction continues to and help to work within the disease's limitations.
spread into the main trunk of the involved nerve, tending to strangle it
so that impulses cannot get up or down and thereby causing loss of
29 30
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