English
From 'slesma' the following symptoms manifest as chilliness, whiteness ( of the macular patches ), pruritus, hardness ( of the nodes), heaviness, elevation (of the nodes, thickening and folding of the skin ), fattiness ( fatty infiltration ) and ( ulcerous ) crusts. qftsq’Rrf. t ft's! ng nm ii qutr^qfifii: ftrswrfwwT pqcir 5ti qfi sifft hi t • d DISEASES 369 “When the microbes eat up slowly the four ( layers) of the skin (epidermis, corium, muesum and corneum ), vessels and nerves ( Mra ), ten¬ dons and tender bones, then there are other com¬ plicating leprous symptoms as exudation, gan¬ grene, deformations, pol;^dipsia, fever, diarrhoea hyperjemia, debility, anorexia and indigestion, in which it becomes incurable”. Charaka II. 6 . JLepwsi/ is caused by Hansen’s ‘bacillus leprcB’ which morphologically has a very striking resemblance to the tubercular bacillus, but according to Jamanito, the tubercular bacillus is stained black by the silver nitrate method, while ' the ‘bacillus leprcc remain transparent. However, a large percentage of the lepers are found either tubercular or syphilitic. And these three diseas¬ es are very alike in their evolution and it is very hard often to diagnose one from the other ■ without differential diagnosis. The 'lepra bacilli’ are found in all diseased tissues, in nasal, sali¬ vary, vaginal and urethral secretions, tears, 162 . ct^^siiPr ^irr^riq i “^o^rg'nicir, at i 24 370 ANCIENT HINDU MEDICINE sputum, semen, macular scales, exudation or discharges from the sores. It seems that the lepra bacillus takes a long period for the evolu¬ tion of leprosy and incubation is very slow lasting from 2 to 20 years. Tiie lepra bacillus is in¬ fectious, but its contagion is not of a virulent type, as is demonstrated by the fact that usually the attendants at the leper asylums with cleanliness of the body, hygienic living and nutritious die¬ tary, escape from this loathsome malady. On the other hand it is undeniable that the segregation of the lepers in Norway, Hawaii and the Philippine- Islands have shown a very promising result, in not only ari’esting the spread of leprosy, but also tending to uproot the disease entirely as it has been done in Europe. However, the mode of its infection is not yet known. It seems the lepra germs find a favor.ible medium for growth, like tubercular bacilli, in an organism devitalized by malnutrition, uticleanliness and unhygienic living. And riiat perhaps explains how with improved living find hygiene, it has practically died out of Europe. It is usually found in the East among the poorer classes wlio suffer from chronic malnutrition and live in unhygienic surround¬ ings in the midst of tilth and misery. The tissues therefore lack the resisting power against DISEASES 37t the invasion of the ‘lepra bacilli’ though they possess but feeble virulence. There are three froms of leprosy : (I) ‘tuber¬ cular leprosy, ( 2 ) muculo-ane'sthetic leprosy and ( 3) mixed leprosy. In the tubercular form, there are repeated attacks of fever as a reaction of the organism against the invasion of the lepra bacilli. There may bo pruritus and hyperesthesia of the skin with neuralgic pain in all locations. In most cases there is a premonitory eruption of vesicles or bullse, affecting tlie extremities chiefly. These bullae appear rapidly, are usually painless, break spontaneously, and often heal as ulcers, leaving behind a pigmented spot, brown, black, or white. Spots gradually make thus their appearance in vtirious parts of the body, and the macular eruption is more frequent as the disease progresses. This may continue for months or years according to tlie resisting power of tlie organism. The small tubercles appear, grow in size and become confluent. They may simply ulcerate, without marked destruction of tissue, leaving small superficial ulcers, covered uith greenish or brown crusts, destroying by degi ees the a-djacent tissues, tendons, ligaments, and finally the bones. If treated, they cicatrize and produce deformities; but if S72 ANCIENT HINDU MEDICINB neglected, they slippurate, and cause amyloidosis or gangrene. Almost from the beginning the senses are disturbed. In the maculo-^nesthetic or tropho-neurotic form of' leprosy, the infiltration principally takes place into the nerves, causing their gradual irritation, inflammation, degeneration and destruction. In the first inflammatory stage, there is hyperesthesia, sensory, vaso-motor and motor disturbances manifested by burning numbness, formication {sensory), flushings of the face, glossy skin {vaso-motot'), twitchings of the muscles (motor) particularly of the face, paroxysms of neuralgic pain and cutaneous manifestation. This is gradually succeeded by a period of nerve degeneration, marked clinically by anesthesia, paralysis, atrophies and distinct trophic disturbances. With the anesthesia, there appears a muscle-atrophy which first of all attacks the muscles of the hand (causing contraction), the extensors and flexors of the forearm, causing the charecteristic ‘claw-hand'. There is loss of power, sense of touch, of heat and cold, even of pain. The muscles of the feet are likewise affected. There is a variety of trophic disturbances at this stage —shedding of the nails, loss of pigment, loss of DISEASES 373 hair, loss of teeth, ulceration, followed by dry gangrene, necrosis and absorption of the bone with the I’esultant mutilation. The 'mixed'' is I’eally the typical form of leprosy, combining the tubercular and tropho-neurotic manifestations, and the symptoms of both types are present. Of course lepra bacillus is found in all Ciises in all leprous lesions, wliether located in the skin, mucous membranes, neryes or internal organs. Malnutrition, uncleanliness, infections of tuberculosis or syphilis which are found among a large percentage of the lepers, not only predispose the organism to leprosy, but also accelerate the progress of this malignant disease and hasten death. Treatment :—‘‘Por a pious leper who wishes to live and for whom the five methods of treatment have not been effective, the wise physician should treat him in the following manner :—Ripe fruits should be/collected, in the rainy season of the 'tuhara' {Faractogenos Kurziirchaulmngra) tree which grows on the southern sea-coast ( Arahan ) and whose branches are agitated bv the wind, raised bv the ocean waves ; the kernel of the fruits is to be taken out, dried and made ihto fragments. And then they should be pressed in a mill like 374. ANCIENT HINDU MEDICINE the sesame-oil press, or the oil extracted in a basin as with the saffron flower ( crocus sativus ). This sliould be put on fire (in a kettle ) and when all the water has been evaporated from the oil, it ought to be taken out and placed ( in a flask ) in dried cow-dung for a fortnight. When the patient has been fattened by the treatment of oils, sweated by diaphoretics, cleansed ( internally ) by purgatives and emetics, then in a lunar auspicious evening, he should drink the oil, consecrated with the hymn that the essence of the kernel is tlie antidote of all poisons, etc. The Hubara’ iphaulmugra) oil causes repeated evacuations of the toxin (of the leprous lesion ) through the upper and lower channels ( chaulmugra oil is very irritant, and causes vomiting and purgation. It should be given in a capsule, or better still, to be effective, ethyl ester preparations of the fatty acids of the ‘chaulmugra oil’ can be administer¬ ed intramuscularly with the iiypodermic syringe ■with marvellous results ). After this cold barley water should be drunk without any salt ( which provokes vomiting ) and fat (which stimulates peristalsis ). Thus he shall drink for five days the oil, and for a fortnight giving up all injuri¬ ous habits as anger etc., shall live on rice and DISEASES 375 the broth of *mudga’ (phaseolus mungo, both of them are constipative ). If thus for five days the patient drinks the oil, he gets cured of all kinds of leprosy. If this Huhara* ®il is cooked together as before with three times the quantity of the decoction of hJiadira {Mimosaferruginacce) and he untiringly drinks it for a month, all leproma become destroyed, Avith the inunction and imbibition of the oil, together with proper dietary, and hoarseness of voice, red-eyes and ulcers eaten by bacteria are cured soon.” Stcsruta IV. 13. 8-9*®3. 163- =3^1^' I tir i fjmiAracT I wtf/ I 1%^ TJW H ^ tjg iravnft II 376 ANCIENT HINBU MEDICINE ‘‘If one eats the kernel of the Huhara* fruit, his body becomes cleansed of all impurities ; it is very potent, and is the best medicine for leprosy.” Siisriita IV. 13. 10*®*. Tiibara or climilmugra ( Taraktogenos kurzii), by which name it is better known, is cei’tainly the best medicine known yet in the treatment of leprosy. A few intramuscular injections of the ethyl esters or intravenous in- i vpsiHfifi i ^T?f' fttfT II tmiv’ aSrtfi spc: i 11 e li^ffcTTf I II I 164. ^ I DISEASES 377 jection of the salts—chaulmoogric and liydnocar- pic acids, result in Hihe destruction of the lepra bacilli in the tissues, followed by the disappear¬ ance of the nodules and healing of the ulcers. The oral administration of the chanlmugra, oil is not so successful, for the reason that it is nauseating and offensive to the stomach, and when injected intramuscularly, it is extremely painful and very slowly absorbed. Its fatty acids—chaulmoogric acid and hydnocarpic acid, being solids, are unsuited for hypodermic admi¬ nistration. But the ethyl esters of these acids,, being thin fluid oils, are well suited for infection and are well absorbed. And they have given remarlcable result within a short time.