The need for study of the potentials of surgery and physiotherapy in leprosy

Doull, James A

ABSTRACT

The problem may be summarized as follows The number of persons suffering from leprosy is very large - certainly several millions, scattered over a wide geographic area but for the most part in warmer climates. Disability is present in more than one-half of existent cases, and occurs ultimately in nearly all. This varies from a slight handicap with only contractures of the fingers to total physical disability with extensive loss of distal parts of the limbs. Disability occurs earlier in the tuberculoid than the lepromatous type, but in the end it is equally frequent in both types It is accompained and contributed to by loss of perception of pain, light touch, and change in temperature in the areas supplied by the affected nerves. Involvement of the temporal and zygomatic branches of the facial nerve is very common and frequently bilateral, leading to inability to close the eyelids tightly with consequent exposure of the cornea to injury. Invasion of the eye, infiltration and nodulation of the skin of the face and ears, ulceration, and scarring add to the deformity in the lepromatous type. Absorption of the bones of the hands and feet has long been considered and inevitable consequence. Recently a more hopeful outlook for prevention has been presented. It is claimed that in a substantial proportion of patients the shortening and eventual loss of difits is caused by secondary infection of wounds or abrasions, to which the anesthetic hand and foot are especially subject. If this view is correct, the prevention of infection becomes a matter of greatest importance. Final considerations which add to the seriousness of the problem are that nerve damage is present in many patients on discovery, and that present-day chemotherapy cannot bu counted on to reverse, and probably not to limit, the degenerative process in the nerves. This latter statement should not be interpreted as implying that early sulfone treatment may not have a beneficial effect, but only that such an effect has not yet been demonstrated.