UNNA'S TREATMENT OF LEPROSY. From
Paper Bead before the Bombay Branch of the British Medical Association
a
By B. II. Nanavatty, l. m. & s., Assistant-Surg eon, Bombay Medical Department, Teacher of Surgery, Clinical Surgery and Midwifery, B. J. Medical School, Ahmedabad.
read Dr. J. L. Milton's pamphlet on treatment of leprosy by Dr. Unua of Hamburg, I was induced to give the remedies and the mode of treatment therein mentioned, a careful and prolonged trial: and I now beg to lay briefly before the Society, my notes of the four cases of leprosy thus treated, and the results obtained after a trial extending over a period of nearly twelve months.
Having
tlie successful
Four lepers in different stages of the disease were?with the kind permission of the Superintendent?selected from the Leper Asylum, Ahmedabad; and treatment by resorcin ointment externally, and icthyol internally as well as externally, was commenced early in July 1890, and continued without any interruption till about the beginning of May 1891. The ointments used at first were those of resorcin and icthyol of the strength of 15 and 40 p. c., respectively, and these were rubbed in over different parts of the body for about 35 minutes every morning and evening, and each part was subjected to the operation of one
remedy exclusively.
Resorcin ointment of a somewhat weaker recommended by Dr. strength than what was used in the beginning, Milton was purposely with a view to avoid the severe irritation aud occasional vesication of the skin produced by the use of a stronger one; even this application after a fortnight's continuous use made the skin of all the patients slightly tender and raw at some 2
INDIAN MEDICAL GAZETTE.
points, so that it was considered advisable to suspend the use of the remedy for two or three days. Later on, the strength of the ointment
was gradually increased, until at the end of six weeks it was raised to 20 p. c., and kept up at this uniform standard till the end of the trial. At the same time icthyol was prescribed internally (in 4-gr. doses 3 times a day) either in the form of a mixture or pills. Being miscible in water, it was often found convenient to give it as a mixture (a little spt. chloroform and tinct. cardam. co., being added to improve its taste and smell) to the use of which none of the patients showed any dislike or aversion for a long time. The above dose was, however, gradually increased, and at the end of about two months it was raised to 10 grs. 3 times a day, beyond which the dose could not be increased, as the patients were not able to tolerate it. For external application icthyol was made up into ointment with vaseline or lanolin, the latter especially, (strength 40-50 p. c.,) and as such was applied for the whole of the period exactly in the same manner as the resorcin ointment, and no irritation of the skin was produced even after its prolonged use. The regular employment of these measures was followed, in the course of about two months and a half, by au apparently decided improvement in almost all the chief symptoms. The face began to lose its repulsive and leoniue aspect, the ears appeared less hypertrophied, less swollen and less anaesthetic than before; the tubercles, which in one patient were very large and covered large areas of the skin over the gluteal, the femoral and other regions became perceptibly smaller and smaller, the blotches over the face and other parts of the body disappeared one by one, and even the conjunctivas lost, to a great extent, their peculiar redness and hue. As time progressed, a further decided improvement in all the symptoms became manifest, and at the end of January last, all the tubercles in two patients completely disappeared, leaving the skin soft and supple, yet anaesthetic, though in a lesser degree than before. At this time, acting upon Dr. Milton's advice (who in one of his letters kindly suggested that I would probably get on still better with my leprosy cases, if I used icthyol and resorcin more freely than lie had stated in his pamphlet), I began to give icthyol in larger doses than 10 grs., 3 times a day, but none of the patients could tolerate the increased dose for more than a week. Every one of them complained of au uncontrollable and prolonged burning sensation in the stomach, accompanied by paroxysms of pain, of a peculiarly gnawing or
twisting character, whilst
one
patient,
a woman
who suffered from severe vomiting, in addition to the above symptoms, got so disgusted with it, that she could not afterwards be induced in
spite
of
a
symptoms, In
r
Jan. 1893.
considerable amelioration in all her to continue her old treatment
again.
of the patients, as an additional symptom, a considerable irritation of the conjunctivas was set up by the increased dose, and as it was clear that they could not tolerate the drug in increased doses, its use was suspended completely for three days, by which time all the unpleasant symptoms disappeared, when it was resumed as before in smaller doses. As stated above, in the early part of January 1891, a considerable improvement was clearly to be seen in all the patients, for the tubercles from all the patients had really disappeared (none of them proving refractory and requiring the use of pyrogallic acid or any other remedy), their appearance had improved considerably, whilst some diminution had also taken place in the autesthesia (but it had nowhere fully disappeared); the patients themselves, fully recognizing the good done to them, cheerfully obeyed all instructions and even some of the other lepers expressed a desire to be treated in a similar manner. All went on well for a time, and it did really appear as if at last, a remedy was found for this loathsome disease. But unfortunately, the patients were doomed to bitter disappointment in the end; for the improvement lasted for a short time only, and but little real impression seemed to have been made on the deep-seated and intractable nature of the disease. It is also a question whether the temporary yet complete disappearance of the tubercles, was due to the regular use of the ointments, or merely to the friction and pressure required in their application. Be that as it may, though the treatment was as carefully carried out as before, the tubercles which had completely disappeared made their appearance again, either as minute granular bodies or tubercles, seated on and underneath the skin of various parts of the body. These, under treatment again disappeared, to reappear again however, and this state of things continued till the beginning of April last, when the patients getting tired of having their bodies rubbed so long, repeatedly begged to have the treatment stopped, which was done at last in the early part of May after a patient trial of nearly The cases selected by me were twelve months. I should at least of four of five years' standiug. gladly have selected (and would do so even now) lepers in the early stage of the disease, but none were available in the asylum, as the lower class of natives seldom seek admission into such an institution, until the disease is more or less advanced, and some mutilation of the extremities produced. It may perhaps be argued, therefore, that the cases selected were too old or too far advanced to be materially and permanently benefitI am not prepared ed by the drugs employed. to deny absolutely the force of this reasoning. In Unna's case (reported by Dr. Milton), the one
Jan.
1893.]
REHIR ON TROPICAL SUPPURATIVE HEPATITIS.
disease, though it had extensively invaded the body, was only of two years' duration and an almost complete cure, even to the disappearance of the
is said to have resulted in eighteen weeks. The above mentioned cases were, however, treated for a period of nearly one year, but unfortunately without obtaining any permanent benefit in a single case. It may, perhaps, be as well to add that attention was paid to the diet of the patients, and that arrangements made for giving the patients a bath (with soap) every alternate day were also
anaesthesia,
seventeen
or
satisfactorily carried
out.
Limited as has been my experience of these drugs, I have ventured to place the results obtained before the members of the Society, and I regret to have to state,?with due deference to Dr. Milton's high testimony to the contrary ?that resorcin and icthyol have failed in my hands,?that the benefits derived from them were, at best, but of a temporary character, aud that they have not justified the expectations that were once formed of them. The Government of Bombay have generously ordered the use of these drugs (for a period of one year), as an experimental measure in the principal leper asylums of the presidency, and I may be allowed to express the hope, that the medical officers who may now be conducting the treatment, may meet with better success, and that they may have a more cheering account to record. /
Paper Bead before the Bombay Branch of the British Medical Association
a
By B. II. Nanavatty, l. m. & s., Assistant-Surg eon, Bombay Medical Department, Teacher of Surgery, Clinical Surgery and Midwifery, B. J. Medical School, Ahmedabad.
read Dr. J. L. Milton's pamphlet on treatment of leprosy by Dr. Unua of Hamburg, I was induced to give the remedies and the mode of treatment therein mentioned, a careful and prolonged trial: and I now beg to lay briefly before the Society, my notes of the four cases of leprosy thus treated, and the results obtained after a trial extending over a period of nearly twelve months.
Having
tlie successful
Four lepers in different stages of the disease were?with the kind permission of the Superintendent?selected from the Leper Asylum, Ahmedabad; and treatment by resorcin ointment externally, and icthyol internally as well as externally, was commenced early in July 1890, and continued without any interruption till about the beginning of May 1891. The ointments used at first were those of resorcin and icthyol of the strength of 15 and 40 p. c., respectively, and these were rubbed in over different parts of the body for about 35 minutes every morning and evening, and each part was subjected to the operation of one
remedy exclusively.
Resorcin ointment of a somewhat weaker recommended by Dr. strength than what was used in the beginning, Milton was purposely with a view to avoid the severe irritation aud occasional vesication of the skin produced by the use of a stronger one; even this application after a fortnight's continuous use made the skin of all the patients slightly tender and raw at some 2
INDIAN MEDICAL GAZETTE.
points, so that it was considered advisable to suspend the use of the remedy for two or three days. Later on, the strength of the ointment
was gradually increased, until at the end of six weeks it was raised to 20 p. c., and kept up at this uniform standard till the end of the trial. At the same time icthyol was prescribed internally (in 4-gr. doses 3 times a day) either in the form of a mixture or pills. Being miscible in water, it was often found convenient to give it as a mixture (a little spt. chloroform and tinct. cardam. co., being added to improve its taste and smell) to the use of which none of the patients showed any dislike or aversion for a long time. The above dose was, however, gradually increased, and at the end of about two months it was raised to 10 grs. 3 times a day, beyond which the dose could not be increased, as the patients were not able to tolerate it. For external application icthyol was made up into ointment with vaseline or lanolin, the latter especially, (strength 40-50 p. c.,) and as such was applied for the whole of the period exactly in the same manner as the resorcin ointment, and no irritation of the skin was produced even after its prolonged use. The regular employment of these measures was followed, in the course of about two months and a half, by au apparently decided improvement in almost all the chief symptoms. The face began to lose its repulsive and leoniue aspect, the ears appeared less hypertrophied, less swollen and less anaesthetic than before; the tubercles, which in one patient were very large and covered large areas of the skin over the gluteal, the femoral and other regions became perceptibly smaller and smaller, the blotches over the face and other parts of the body disappeared one by one, and even the conjunctivas lost, to a great extent, their peculiar redness and hue. As time progressed, a further decided improvement in all the symptoms became manifest, and at the end of January last, all the tubercles in two patients completely disappeared, leaving the skin soft and supple, yet anaesthetic, though in a lesser degree than before. At this time, acting upon Dr. Milton's advice (who in one of his letters kindly suggested that I would probably get on still better with my leprosy cases, if I used icthyol and resorcin more freely than lie had stated in his pamphlet), I began to give icthyol in larger doses than 10 grs., 3 times a day, but none of the patients could tolerate the increased dose for more than a week. Every one of them complained of au uncontrollable and prolonged burning sensation in the stomach, accompanied by paroxysms of pain, of a peculiarly gnawing or
twisting character, whilst
one
patient,
a woman
who suffered from severe vomiting, in addition to the above symptoms, got so disgusted with it, that she could not afterwards be induced in
spite
of
a
symptoms, In
r
Jan. 1893.
considerable amelioration in all her to continue her old treatment
again.
of the patients, as an additional symptom, a considerable irritation of the conjunctivas was set up by the increased dose, and as it was clear that they could not tolerate the drug in increased doses, its use was suspended completely for three days, by which time all the unpleasant symptoms disappeared, when it was resumed as before in smaller doses. As stated above, in the early part of January 1891, a considerable improvement was clearly to be seen in all the patients, for the tubercles from all the patients had really disappeared (none of them proving refractory and requiring the use of pyrogallic acid or any other remedy), their appearance had improved considerably, whilst some diminution had also taken place in the autesthesia (but it had nowhere fully disappeared); the patients themselves, fully recognizing the good done to them, cheerfully obeyed all instructions and even some of the other lepers expressed a desire to be treated in a similar manner. All went on well for a time, and it did really appear as if at last, a remedy was found for this loathsome disease. But unfortunately, the patients were doomed to bitter disappointment in the end; for the improvement lasted for a short time only, and but little real impression seemed to have been made on the deep-seated and intractable nature of the disease. It is also a question whether the temporary yet complete disappearance of the tubercles, was due to the regular use of the ointments, or merely to the friction and pressure required in their application. Be that as it may, though the treatment was as carefully carried out as before, the tubercles which had completely disappeared made their appearance again, either as minute granular bodies or tubercles, seated on and underneath the skin of various parts of the body. These, under treatment again disappeared, to reappear again however, and this state of things continued till the beginning of April last, when the patients getting tired of having their bodies rubbed so long, repeatedly begged to have the treatment stopped, which was done at last in the early part of May after a patient trial of nearly The cases selected by me were twelve months. I should at least of four of five years' standiug. gladly have selected (and would do so even now) lepers in the early stage of the disease, but none were available in the asylum, as the lower class of natives seldom seek admission into such an institution, until the disease is more or less advanced, and some mutilation of the extremities produced. It may perhaps be argued, therefore, that the cases selected were too old or too far advanced to be materially and permanently benefitI am not prepared ed by the drugs employed. to deny absolutely the force of this reasoning. In Unna's case (reported by Dr. Milton), the one
Jan.
1893.]
REHIR ON TROPICAL SUPPURATIVE HEPATITIS.
disease, though it had extensively invaded the body, was only of two years' duration and an almost complete cure, even to the disappearance of the
is said to have resulted in eighteen weeks. The above mentioned cases were, however, treated for a period of nearly one year, but unfortunately without obtaining any permanent benefit in a single case. It may, perhaps, be as well to add that attention was paid to the diet of the patients, and that arrangements made for giving the patients a bath (with soap) every alternate day were also
anaesthesia,
seventeen
or
satisfactorily carried
out.
Limited as has been my experience of these drugs, I have ventured to place the results obtained before the members of the Society, and I regret to have to state,?with due deference to Dr. Milton's high testimony to the contrary ?that resorcin and icthyol have failed in my hands,?that the benefits derived from them were, at best, but of a temporary character, aud that they have not justified the expectations that were once formed of them. The Government of Bombay have generously ordered the use of these drugs (for a period of one year), as an experimental measure in the principal leper asylums of the presidency, and I may be allowed to express the hope, that the medical officers who may now be conducting the treatment, may meet with better success, and that they may have a more cheering account to record. /
