Plantar hyperalgesia and the prognosis ans treatment of leprosy

1- Hyperalgesia of the deeper structures of the foot, as elicited by heavy stroking of the sole, has been found to be a usual accompaniment of lepra reaction in the lepromatous type of leprosy. 2- Out of 1,117 lepromatous cases examined, 477, or 43 percent, had plantar hyperalgesia of varying degrees. The records of these patients showed that most of them were not doing well. 3- Out of a control series of 422 nonleper patients, only 11, or 2.6 percent, had plantar hyperalgesia. In each of these cases the underlying cause - inflammation of ankle joints, etc. -was readilçy discernable. 4- In a small series of cases, patients with plantar hyperalgesia showed a tendency towards a higher erythrocyte sedimentation rate than did those with normal plantar sensation. 5- In a similar series, patients with plantar hyperalgesia showed a greater incidence of positive bacteriological findings in thick blood films than did cases with normal plantar sensation. 6- Twelve patients, ten of whom had normal deep plantar sensation and two of whom had slight pain on pressure, were given carefully graded, increasing doses of potassium iodice. In all of these cases the first indication of increased activity of the disease was increase of pain on plantar pressure. Upon recovery, sensation tended to revert to normal. 7- From the above experiments it is suggested that lepromatous leprosy can be divided into three zones (a) static or improving, with normal plantar sensation, (b) activated, with plantar hyperalgesia, and (c) "reacting", associated with considerable pain on plantar pressure. 8- The method by which this test came to be evolved is described and its practical use in prognosis and treatment is outlined.

Acute ulcerative or sloughing tuberculoid leprosy

The process here described as acute ulcerative tuberculoid leprosy appears at present to be unknown outside Malaya, and so far has been found here only in Chinese patients. The condition is essentially a rapid flare-up of acute tuberculoid leprosy, going on to exfoliation (occasionally with punctate hemorrhages), and sloughing out of the tuberculoid tissue. It is accompanied by low fever and rapid loss of weight. Except with specific treatment its progress is intractable and slow, and it leaves considerable deformity and deep scarring. In my experience the process can be controlled only by very large doses of hydnocarpus oil given subcutaneouly, accompanied by inunctions of hydnocarpus ointment to the ulcerated areas. To one who has previously dealt with the condition by other methods, the treatment described is avery convincing, and indeed striking, vindication of the use of hydnocarpus derivatives.

On the use of fluorescein and phthallic acid in leprosy

(1) In the treatment of leprosy cases with intravenous injections of aniline dyes, fluorescein has seemed to us to give the most stable effects. (2) Sixty-four cases have been treated with intravenous injections of fluorescein over a period of four months. (3) After six weeks treatment about 60 per cent of these cases showed greather or less specific response, based on clinical examination of the lesions and laboratory findings. (4) The improvement rate dropped to 43 per cent on continuing the treatment for four months. (5) Nine cases have been treated with resorcin blue (resorcin being one of the components of fluorescein). No effect was obtained. (6) Sixteen patients have been treated for two months with intravenous injections of phthallic acid (the other component of fluorescein) with greater or less lesion response in 62 per cent of cases.

The therapeutic effects of phthalic acid salts

The magnesium, calcium, potassium-hydrogen and cotarnine salts of phthalic acid have been tried out, on twenty patients each, over a period of six months by intravenous injections twice a week. Intravenous injections of magnesium, calcium and potassium-hydrogen phthalate appear to have no therapeutic effect in leprosy in doses of 20 cc. of a 1 per cent solution. Out of nineteen cases treated with intravenous injections of cotarnine phthalate, in 20 cc. doses, first of a 1 per cent solution and later a 2 per cent solution, twice a week, twelve showed marked improvement, four slight improvement and three no change. The inprovement in these cases occurred only during the first three months of treatment. The clinical improvement appears to be accompanied by a general increase in resistance as indicated by a drop of over 25 per cent in the sedimentation rate of twelve of the patients. It is suggested that the effect of the phthalate group in leprosy is dependent to some extent on the length of time the drug is retained in the body.

A preliminary report on the action of certain dyes in leprosy

1- A number of indications and analogies suggest the trial of coal-tar dyes and their derivatives in leprosy. 2- Intravenous injections of a large number of dyes have been given to 85 patients. 3- A number of these dyes show marked selective concentration in the leprotic lesions, a phenomenon not seen in certain non-leprotic lesions. 4- With trypan blue, brilliant green, fluorescein and perhaps eosin a definite diminution of the external manifestations of leprosy has been observed, accompanied by other signs of clinical improvement. 5- With the other dyes administered no signs of clinical improvement were observed. 6- This report is a study of the immediate reaction of the lesions; we have as yet no knowledge of the later effects of the injection of these dyes. We consider from this preliminary report that further trial and study of these dyes is definitely indicated in the hope that it may lead to further possibilities in the chemotherapy of this disease.