[Prognosis in leprosy].

O NE so often hears varying and contradictory state­ ments with regard to the ultimate outlook in treatment, that it may be of value to sum up the present position. The prognosis or ultimate end of leprosy has to be viewed from a slightly different standpoint than is the case in many other diseases. The disfigurement that the disease produces in th e later stages, the deformities that so often result, and the social stigma attached to the leper, all make it of utmost importance that something more than a mere eradication of the disease should be the aim. If the " cure " results i n mutiliation and physical deformity, the position of the patient socially is in no way changed, and he cannot in most cases resume normal life. Therefore the obj ect of all treat­ ment is to render th e patient free from all signs of active disease, and of the stigma which so. often accompany the arrest of leprosy. The late Dr. Hansen summed up the situation for the leper ill his day most vividly in his book "C linical and Pathological Aspects of Leprosy " when he said : " Lepers usually die before the disease has run its course. But in the maculo-anresthetic (nerve) form the cure of leprosy is very different. We have occasionally a complete subject with vigour and good health, but usually only a miserable rudi­ ment of a human being, with more or less paralysed and deformed hands and feet with unclosable eyes, of which part of the cornea is opaque, and from which tears run down over th e cheeks, and with paralysed fa cial muscles unable to close the mouth, so that saliva constantly dribbles from it. Such cases, may, however live long, and reach great ages, if under such circumstances this can be looke� upon as any advantage." ... " In nodular leprosy, the bacilli in the leprous products break up into granules which finally disappt:: ar, and there remains of the leprous product only a scar in which nothing leprous can be recognised. Occa�ion­ ally a widespread anresthesia, th e result of nerve affections; and in the. maculo-anresthetic form this is the regular termination of the disease. In both cases the leplOsy is completely healed." Today , however, the chances of completely healing the leper without permanent deformity are .much greater. It is, however, unreliable …