Modern Indian leprosy : being the report of a tour in Kattiawar, 1876 : with addenda on Norwegian, Cretan and Syrian leprosy.

  • Carter, H. V. (Henry Vandyke), 1831-1897.
Date:
1876
Catalogue details

Licence: Public Domain Mark

Credit: Modern Indian leprosy : being the report of a tour in Kattiawar, 1876 : with addenda on Norwegian, Cretan and Syrian leprosy. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    1.—M., Kumbbar, set. 35, born near Datha, here for about 10 years, which is also the length of time his symptoms have existed, hence it is doubtful if these latter came on here. It is a characteristic example of advanced A. L.; the middle finger of the right hand was first affected, and an eruption appeared on the same forearm at about this time. The man is now crippled; and I notice the curious limitation of numbness in the hand (both surfaces) to a line traversing the wrist-joint: possibly there is some diminished sensation in the forearm and there are pale spots on the limbs said not to be numb. As the case is of import in diagnosis, I append some details: there is a peculiar expression of the face due to partial paralysis of the right side : nothing visible on the trunk: pale spots at right elbow aud on forearm, possibly at back of wrist; the same on the legs; the right hand is alone affected and that extremely so, the terminal phalanges and fingers gone and the nails exist as small pointed knobs tipping the stunted middle phalanges : thumb comparatively lesschanged, it isstiff ; there are atrophy and retraction of the fingers and palm (claw-hand), and bronzing, and universal numbness, even in the palm, extending to just above the wrist, with hardly any change in the usual appearance of the skin at this part. Spots on forearm though rather character- istic in aspect, yet not rounded and with a look foreign to the true leper spot of this variety—are said not to be numbed: on the left forearm and hand are two large pale discolora- tions, occupying the inner side and back (they are six inches long, and looking like mere pigmentary changes; they are, however, decidedly benumbed) : this hand is otherwise quite unaltered. Muscular power is hardly anywhere diminished. Whilst the right foot is not much changed, the left foot is greatly maimed, being shrunken and black, toes wasted and twisted, the whole giving the impression of being mummefied or affected with dry gangrene: hence the man's lameness and peculiar gait. Parents not affected : does not know of others like himself (a stupidish man) : brothers and sisters not so, they are older than he; cannot explain his being the only sufferer: was working with the hoe in the field when the symptoms came on : fancies some one must have cast a‘spell’ over him. Is married : 3 small children, all well; has travelled but chiefly after the beginning of the disease, cannot say anything of his ancestors or of possible contact with other lepers elsewhere : denies syphilis. Lives with his family and eats with his caste-men as if nothing had happened, yet there are running sores. Is said to be the first leper known here. An obscure case simulating mere neuritis (right hand), but indicating true leprosy (left hand), whence a case of some value in diagnosis: condition of ulnar nerves not ascertained. 2.—The other supposed leper was a woman working in the fields, who was fetched for me to see—the wife of a Kumbhar living close to the above man (whose house is a very poor and dirty place) : she is adult and a hard-worker, so that her hands, &c., have the appearance of being much worn : there is, too, some ulceration about the nose, but no- where that I could see on cursory inspection, any undoubted signs of true leprosy about her: no children : no acknowledged taint. A case imperfectly investigated, but probably misappre- hended as a leper : the influence of hard manual labour, and of long trudging on heated ground, &c., in inducing local neuritis of hands and feet, is a point calling for study : there is, too, the possibility of some infection or inoculation occurring, particularly in the extremities and leading to their first or especial implication. 29th January.—At Wanda, 7 cos3 to the W. in the plain and on the banks of a stream : about 300 houses : population mixed (1,008), being mostly Kunbis, then Kolis, Kumbhars, ‘ SagarB’ (a kind of Kunbi), Garassia, Bhurwad, artificers, 1 Wfinka’ (wanja), weavers of cloth (cotton), who eat with Sutars, See.: Khojas; Shravuk-wanis and Brahmans. Common foods— bajra, jowra ; urid, mung ; oil from seeds : no fish (which is very scarce here) is consumed, except, perhaps, by the lowest casteB. Water from draw-wells only: river-water not used for drinking : no guinea-worm here : fever is the commonest fatal complaint, and chest complaints seem rare. Leprosy occurs. A large, clean village with a new school-house, and attempts at outward order : heaps of refuse still abound, but in this hot dry air there are no collections of stagnant and foul water, and consequently bad smells are fewer than they might be in an English village : filth here is desiccated, there satu- rated. Eye-complaints amongst children and adults are not so frequent as would be expected, from the clouds of dust which darken the air at morn and eve, when cattle pass out and in along the narrow lanep, and ploughs are dragged about, not carried; not to mention many other disturbing causes. With so much accretion of decomposing organic matter and germ-bearing dust, one wonders that so many people remain well. The sewage question is disposed of as elsewhere, and a stroll into the lanes surrounding the village, which might be a recreation, becomes unbearable and impossible : children all day long use the common streets, and others during the night in dark lanes ; the ground being so dusty and parched, it may be said that the dry earth system is unwittingly here carried out. Wells abound for irrigation purposes, some- times the water is of good quality as here, and sufficient in amount: surface-water at a depth of about 20 feet at this season, and somewhat lower in the hot weather. The village is said to be thriving : it contains the remains of a round tower or fort, 200 years old; there are a few trees around and some irrigated land. Lepers seen. 1.—F., Kunbin, set. 32, born at a distance, here for 20 years ; disease since 8 years, it began at the great toe of the left foot and then attacked the right foot. A. L.: the woman is intelligent: nose sunken (there has been necrosis of the nasal bones) : no eruption detected in the trunk : upper limbs only slightly affected, some fingers are swollen and crooked, on back of right hand is a visicle from a burn, numbness here and on adjoining parts of forearms : feet more changed, left great toe reduced to a mere knob and the other tots atrophied and twisted: right great toe quite gone and the adjoining ones are considerably affected (/ internal plantar nerve region) : numbness is limited to the parts below the ankle-joint, just as it is most marked below the wrists. Married : 2 daughters of 12 and 8, well : no child born after the beginning of the disease. It is said that her paternal grandfather was a leper : father was free. Her disease came on here, and about that time there were four other lepers in the village, all of whom are now dead (statement from patel), and their children have gone away to Junagurh. The last of these lepers died some seven or eight years ago : three of them were Kolis : they lived in different parts of the village : two were mother and daughter, and one (a Wani) was the father of No. 3 below : the remaining case was a Koli man and seem- ingly unconnected -with the rest : these instances were probably both A. L. and T. L. Syphilis is denied on behalf of both this woman and her husband. 2.—M., Khatri (keeps a shop for condiments, &c.), set. 30. born and resident here : leprosy for 5 years, it began, he thinks, with an eruption on the body, following by implication of the feet and lastly of the hands. At present, there are on the face the signs of early T. L.; ears thickened and pendant ; brows overhauging and destitute of hairs: cheeks puffed, opacity of left cornea since infancy. On trunk nothing visi- ble : hands somewhat deformed, the two inner fingersof right hand are tumid, bent, stiff and shortened : in the left hand the little finger has become permanently flexed and shortened, pale and smooth, and its terminal phalanx wasted and deflected, hence the hand at the back looks like that of a painted mediaeval saiut. Numbness is not marked anywhere except at this little finger. Feet more changed : on the right side the nails are deformed as well as the toes ; and so on the left side : a blister on dorsum of fourth toe : existence of numbness uncertain, the man being rather stupid. Parents dead : he is the youngest of 2 brothers and 4 sisters, all well but him : F. was a leper and died 11 years ago, so that it was not until 6 years after the death of his father that he showed the same disease : the father lived here and probably had T. L. for 5 or « years before he died. He is th*> only leper in his family : his nephews and nieces are well. Married and has 3 children tut. 13, 10 and 8, none born after the disease began : he lives in the same house as his family, but eats apart: wife sepa- rated and well. Denies syphilis, but speaks of a sore about