(5)
(hectic) are common, the appetite is lost, and the patient sinks from exhaustion,
or is carried off by diarrha or a local inflammation.
(c)-A pure case of this variety is very rare. The ulcerative process is preced-
ed by the formation of blisters on the fingers and toes, and sometimes on the
palms of the hands and plantar aspect of the feet. The blisters burst, exposing
very unhealthy looking ulcers which heal very slowly, and are followed by contrac-
tion of the parts upon which they were situated. After repeated crops of these
blisters the fingers and toes fall off, then other symptoms of leprous cachexia appear,
and the patient is carried off in the manner already described.
No. 55, dated Hooghly, the 30th October 1877.
From-The Offg. Civil Surgeon, Hooghly.
To-The Deputy Surgeon General, Presidency Circle.
WITH reference to your memorandum No. 3173, dated the 29th instant, I have
the honour to inform you that leprosy is very rare in this district. The few cases
that have come under notice are chiefly professional beggars coming to implore
for alms. The Hindus in the Sanskrit works state four forms of the disease. I
have seen only two varieties; in short, they are the same only in different stages.
In one the disease commences with tingling sensation of a patch or patches of skin
in several places, which become benumbed or insensible, and the colouring pigment
of the skin is removed, the part assumes a peculiar appearance tending to a pink
or reddish hue; the skin becomes thickened, and thus the affected part appears
circular; ultimately the tip of the nose and the lobes of the ears and the skin
of the eyebrows become swollen and reddish, and the ends of the fingers and
toes, specially the big toe, gets painful and flattened, swollen and become of
reddish hue; and in some the disease remains stationary in this stage for
years, and even till death of the patient, or the disease advances to ulceration
and loss of joints. The ulceration generally commences in the toes and fingers
first, and as it advances the joints of the fingers and toes are separated. A
sort of serum, like discharge, exudes through the ulcerated part, and the
regular pus is not formed. When healthy pus is discharged from the ulcer, it is
generally considered that the ulceration stops and healing commences. The other
variety is of the same nature in the first stage, but in the second stage dry
gangrene sets in on the toes, in the finger or fingers, and toe or toes, and it
proceeds as far as where the ulceration commences; and if the progress of the
disease is to stop, then healthy pus is seen, and the gangrene part is separated
and the ulceration heals up with healthy granulations. I have seen in several
cases the toes and the rest of the foot fall off by dry gangrene in this way of the
ankle where the ulceration commenced and healed up.
2. The disease is generally observed to commence between the age of 25
and 50, but it has appeared in earlier years, but never seen by me to begin above
the age of 50. The earliest manifestations are the tingling and benumbed state
of the skin of some parts, or the swelling of the tip of the nose, lobes of the ears
and its reddish hue, with or without insensibility of the parts.
I have seen the full development of the disease generally in adult age and
in some cases before puberty; I have rarely seen any case to prove fatal. I have
seen more lepers among men than in women, and more among Muhammadans than
among Hindus; but it is hard for me to give the exact proportion of it. The leprosy
is more frequently seen in the lower order of the people, such as beggars; but
the disease has been seen among the richest also, and it appears to spare no con-
dition of life.
In the District of Hooghly there is no place where it is common; therefore, I
cannot say what locality favours its growth or where it occurs most. It has been
equally seen in all sorts of climate and places.
The sanitary conditions of the dwellings of the inhabitants of this district
are nearly all alike, and there is nothing peculiar in any part of the district deserv-
ing mention. The habits of life as to personal cleanliness, I can say that the
Hindus of this district are generally most clean, daily bathing and washing
their clothes and utensils and rooms; but the Muhammadans, excepting those who
are in good condition, are not comparatively so clean as their Hindu brothers.
They do not bathe, wash and clean every day.
The diet of the people are in general vegetables, milk, fish and ghee. In addi-
tion to these the Muhammadans at times eat meat.
Their mode of living, excepting a few young Bengalis, is very temperate;
they touch neither wine nor stimulating liquor of any sort; they are in general a
race of cultivators.
B