RELIGIOUS ENCYCLOPEDIA
Leprosy
nut, and are either slightly raised above the level of the skin, or quite prominent; dirty-brownred in color and glistening; hard-elastic to soft to the touch; covered with epidermic scales; diffused or closely pressed together, and forming either irregular uneven plaques, or regular circles. They are principally located on the face and ears. On the eyebrows they form thick parallel rows, projecting over the eyes; on the cheeks, nose, and chin they are massed into irregular heaps. The lips become thick, swollen, and protruding; the under lip hangs down; and this, with the prominent, overhanging, knotty eyebrows, and the deeply wrinkled forehead, gives the countenance a morose and stupid appearance. Sometimes the eyelids are everted, and the lobes of the ears hang down in thick masses. Consequent upon the eversion of the eyelids, disease of the eye sets in. The extremities also become tuberculated, though not so much as the face; and the presence of tubercles in the palms of the hands and soles of the feet render handling and walking very painful. Tubercles appear in the mucous membrane of the mouth, pharynx, and upper part of larynx; the tongue becoming thick and cracked, with loss of taste ensuing ; the larynx becoming narrow, with loss of voice; the breath becoming sweetish. After many months, these tubercles may be absorbed, leaving behind dark pigmented atrophic places; sometimes they soften centrally, and spread out peripherally; sometimes break down, and form leprous ulcers, which tend to skin over, only to break down again. Sometimes the ulceration goes deeper; necrosis joins itself to it; a diffused inflammation sets in, leading, in the under extremities especially, to deep excavation, and finally opening of joints, and selfamputation of entire members {Lepra mutilans). Earlier or later anesthesia develops in different parts of the body, and the ulnar nerve will be found enlarged and cord-like. The disease is generally chronic, lasting some eight to ten years, the patient dying of specific marasmus, or some complicating disease of internal organs. Or the disease may be more acute, with high fever, and reaching in a few months to a state which in other cases is not reached in years.
Lepra maculosa is characterized by the appearance on the skin of a large number of red or brown glistening spots, or by diffuse dark pigmentation, intermixed with which are white points, spots, or stripes; so that the body seems streaked. This frequently changes into the former variety, or into Lepra ancesihetica, in which anesthesia is the marked feature. It succeeds to the preceding forms, or else begins with an outbreak of pemphigus bulloe (water-blisters), which, on healing, leave white, glistening, and anesthetic places, or, breaking, leave ulcerations. Sometimes
6. Lepra anesthesia appears on fully normal
Maculosa; places; sometimes the spot has been Lepra red and hyperesthetic for months
Anaesthet- before. Over the anesthetic spots
ica. the skin often becomes wrinkled, the
wrinkled places being bounded by a
red, hyperesthetic border; the wrinkling only taking
place where the anesthetic spots have become
stable, for at first they tend to change their location. The anesthesia is complete, the patient not feeling a needle thrust deep into the muscles. The chief nerve-trunks become swollen, and painful to pressure. Sometimes hyperesthesia precedes anesthesia to such a degree, that the patient is not able to sit or lie for any length of time in one place, can not take anything in his hands, and walking and standing give him the greatest pain. The anesthesia is followed by atrophy of muscles, and wrinkling; the sphincter muscle of the eye becomes lamed; the under eyelid and the under lip hang down; the tears flow over the cheeks; and the saliva runs dribbling out of the mouth; and thus the face oftentimes, already swollen and out of shape by the presence of the tubercles, assumes a peculiar, old, idiotic, or foolish expression. The flexor muscles of the hand not being atrophied so much as the extensor, the fingers become half bent, the hollow of the hand becomes convex and pressed forward, the back of the hand bent in; the finger-ends become clubbed, finger-nails thinned; the hair falls out. Ulceration finally sets in at the anesthetic places, or the tissues gradually atrophy away till the skin, fasciae and tendons disappear, one or another joint is laid bare, when suddenly a whole foot, hand, or extremity falls off. The patient grows foolish and apathetic, and dies after some years. Treatment is largely symptomatic. The best is to remove the patient from leprous regions.
The lepers whom our Lord healed were probably not afflicted with Elephantiasis Grecorum, but with Elephantiasis vulgaris (Psoriasis).
The cause of leprosy is the invasion of the skin by the bacillus lepra, an organism discovered by Hansen in 1874. The disease is contagious, and not hereditary. It occurs in both sexes, but rather more frequently in men. Its period of incubation is very long. While it is wide-spread over the world it is endemic in certain regions. It seems that either a damp and cold climate, or a hot and moist one, favors its development and spread, and that food bears no relation to it. Some, however, insist that it is due to the eating of fish. G. T. Jackson, M.D.
Bibliography: K. Wolff, Leprastudien, Leipsio, 1885; H. Leloiz, Traite de la lepre, Paris, 1886; A. Lutz, Zur
Morphologie des Leprabacillus, Hamburg, 1886; G. Thin, Leprosy, London, 1891; E. A. Senft, Soixant-quinze annees parmi les lepreux, Neuchatel, 1893; G. A. Hansen and C. Looft, Leprosy in its Clinical and Pathological Aspects, Bristol, 1895; E. Besnier, Sur le lepre; role ttiologique, Paris, 1897; V. Babes, Untersuchungen uber den Leprabacillus und uber die Histologic der Lepra, Berlin, 1898; J. Hutchinson, Leprosy and Fish Eating, Chicago, 1906. An important pamphlet, Beobachtungen uber den AussatzimheiligenLande (Herrnhut, 1908), is by Dr. Einsler, for nearly twenty years head of the Jesus Hilfe Hospital for Leprosy in Jerusalem.
For the Biblical side consult: J. R. Bennett, Diseases of the Bible, London, 1887; G. N. Munch, Die Zaraath der hebraischen Bibel; Einleitung in die Geschichte des Aussatzes, Leipsic, 1893; W. M. Thompson, The Land and the Book, ii. 516-520, 200, New York, 1859; E. C. A. Kiehm, Handworterbuch des biblischen Altertums, pp. 155- 159, Leipsic, 1893; J. F. Schamberg, The Nature of the Leprosy of the Bible, in Philadelphia Polychrome, vii (1898), nos. 47-48; Benzinger, Archaologie, pp. 481-482; DB, iii. 95-99; EB, iii. 2763-68; and literature under Diseases and the Healing Art, Hebrew. On the Biblical prescriptions regarding it the one book is A. Dillmann and V. Ryssel, Die Bucher Exodus und Leviticus, pp. 553 sqq., Leipsic, 1897.
Le Quien Leslie