Aug., 1950] EDITORIAL 347

Indian Medical Gazette

AUGUST

LEPROSY TAMED

Hope was brought to the leper by Sir Leonard Rogers in Calcutta in 1915 (Megaw, 1950). His new preparations from old remedies reduced the period of treatment considerably. In one year he cured a brother officer who remained free from relapse for ten years (until killed in an

accident). His work, on his retirement from the I.M.S. in 1926, was taken up by Dr. E. Muir who made to the treatment a few additions, including an intensive treatment with the

original chaulmoogra oil. Dr. Muir, in the Calcutta School of Tropical Medicine, was

followed by Dr. John Lowe and the latter by Dr. Dharmendra, the present head of the

department of leprosy in the School. The next advance in treatment came in 1943

from the U.S. National Leprosarium, Carville

(Faget et al., 1943). The sulphone drugs had been introduced. Typically, in the aromatic

series, they consist of two benzene rings linked by one molecule of sulphur dioxide. In 1947, Dr. Muir in a report from the West Indies said that for the infective type of leprosy he had not seen any drug so successful as the sulphones (Muir, 1947). In 1950 appeared an account of the treatment

in Nigeria by Dr. Lowe (Lowe, 1950; abstract in this journal, Current Topics, 1950). In this issue Dr. Dharmendra has written at

length on the present status of sulphone treat- ment in leprosy (p. 348). A lengthy abstract of another paper appears on p. 370. From the start made by Sir Leonard Rogers

in Calcutta in 1915, with salts made from a

Well-known oil to the introduction of the sul- .phones in 1943, in 26 years, leprosy has been tamed. The cost of taming suits the alleged Asian

poverty. The annual cost of treating a leper, need not exceed Rs. 30, following a bi-weekly injection method of treatment as practised in Calcutta at the School of Tropical Medicine and the Gobra Leprosy Hospital (Sen, 1950).

Incidentally, the early sulphones were at first considered unsuitable. We should not be

surprised if streptomycin, specially along with PAS, is found to succeed also, on further trial. It has been so far considered unsuitable.

The taming was preceded by a loss of

prestige : Nerve leprosy was no longer con-

sidered infectious. The patients were no longer segregated. Another possibility suggests itself :

Is Mycobacterium, lepra like its cousin Myco. tuberculosis hominis a dying organism ? It is Well known that a decline in tuberculosis was recorded in England long before any measures Were taken against it (Wilson and Miles, 1946).

Something similar appears to have occurred to

leprosy also : it lias disappeared from wide

geographical tracts steadily since the middle

ages. Its course also appears to have become mild. Its terror as given in the Old Testament, the practice of throwing handfuls of earth and performing a burial service on the newly isolated lepers in Europe in the middle ages (Rogers, 1950) and burying alive of lepers in India

(Greval, in press), all point to the same con- clusion. Thinking obviously retrospectively from the present position, some writers have stated that the infectivity and gravity of

leprosy have been seriously over-estimated

(Hyman, 1946). The Indian opinion is that all types of leprosy have always been milder here than elsewhere.

Among the many remedies for this ancient disease has been included a multitude of prepara- tions from minerals, vegetables and animals. One such fairly recent preparation is diphtheria toxoid which has proved efficacious in Thailand (Siam) but not in the U.S.A. (Hyman, loc. cit.). Its synergic aid may be useful. The fact that in the immunization against diphtheria the toxoid

(APT) can be given more safely to young- children than to older children and adults

(Parish, 1948) suggests that an allergic state in the subjects is responsible for a reaction. The reaction due to one allergic state, namely, sensitization with diphtheria, may help against another allergic state, namely, sensitization with leprosy. It is an observed fact that in cases of

multiple sensitivity desensitization with one of the antigens concerned renders the subject non- sensitive to other antigens also. The first reaction forms in the sensitive cells a pattern which prevents further antigen-antibody reactions. It is possible to evoke with the toxoid intentionally a mild desensitizing reaction.

REFERENCES

Current Topics (1950). Indian Med. Gaz., 85, 275.

Faget, G. H., Pogge, Public Health Reports, 68, R.G., Johansen, F. A., 1729. Duian, J. F., Prejean, B. M., and Ecdes. C. G. (1943). i

Greval, S. D. S. (In Lyon's Medical Jurisprudence press). for India. Thacker, Spink

and Co. (1933), Ltd., Calcutta.

Hyman, H. T. (194G) .. An Integrated Practice oj Medicine. W. B. Saunders Co., Philadelphia and London.

Lowe, J. (1950) .. Lancet, i, 145.

Meoaw, J. W. D. (1950). Happy Toil. By Sir Leonard Rogers. Frederick Muller, London.

Mtjir, E. (1947) .. Int. Journal Lcp., 15, 309.

Parish, H. .T. (1948) .. Bacterial and Virus Diseases. E. and S. Livingstone Ltd., Edinburgh.

Rogers, L. (1950) .. Happy Toil. Sen, P. (1950) .. The Statesman, 17th July.

Letters to the Editor. Wilson, G. S., and Topley and Wilson's Miles, A. A. (1946). Principles of Bacteriology

and Immunity. Edward Arnold and Co., London.