A Case of Indigenous Leprosy. 
BY 
A, H, OHMAITN-DUMESNIL, AX, «.D, 
OF ST. LOUIS. 
Paper read before the Mo. State Medical 
Association, April, 1888, 
Reprint from St. Louis Medical and Sur- 
gical Journal, May, 1888. A Case of Indigenous Leprosy.* By A. H. Ohmann- 
Dumesnil, A. M., M. D., of St. Louis. 
A few years ago the number of cases of leprosy existing 
in the United States was very small. All those afflicted with 
this disease were known and carefully catalogued. The large 
influx of immigrants to this country has contributed to in- 
crease the number of those suffering from leprosy, to such 
an extent that it would be a difficult task to establish a correct 
census at this day. While the majority of cases are imported 
a few indigenous cases are occasionally seen in localities that 
are widely separated from each other, and in which neither 
the climatic, social nor hygienie conditions are at all alike. 
The case which I propose to report is one of these sporadic 
cases, observed in St. Louis and the first case of the disease 
occurring in the State of Missouri. The clinical and family 
history of the case is, in brief, as follows : 
Mrs. C. S , 25 years of age, married and multipara 
stated that she was an American, born in Mississippi. Her 
grandparents were born in this country and died old. She 
had never learned of their having any constitutional disease. 
Her father was living and in good health His age at the 
time (1887) was 65. He was stout in build and promised to 
live many more years. Her mother was dead. Pneumonia 
was the cause of her death which occurred at the age of 42. 
She had always been a healthy woman. Mrs. S had four 
sisters and one brother. The brother had died of diphtheria. 
Of the sisters two were living, one being in good health. One 
had died in parturition; but what the immediate cause of 
death was, she could not say. The other sister died of a cause 
with which she was unacquainted. The living sister, not in 
good health, was insane, her affection being melancholia. 
The patient's personal history was about as follows : During 
childhood she had always been healthy. She continued so 
during puberty. She first menstruated at the age of 16 the 
process being normal. It continued to remain so. She was 
married in 1881, at the age of 19. When she was 20 years 
old she bore a child, the labor being normal. This child died 
soon after its birth, of cholera infantum. At the age of 23, 
she had another child, a girl, which is still living. This 
* Read before the Missouri State Medical Association, April, 1888. 2 
child is two years old and has always been healthy. She ap- 
pears well-nourished, and the only disease she ever suffered 
from was varicella at the age of one year, and chills and fever 
a few times. 
Mrs. S stated furthermore that she was stout when a 
girl and had always been healthy. When an infant she had 
measles and once again at the age of six years. She also had 
varioloid when a child. 
After she had borne her first child she had no lochia, but 
three months later she " swelled" and white " lumps" like 
hives appeared on her skin. The localities attacked were the 
hands, face, ears and trunk. 
When questioned as to any previous eruptions she stated 
that in the spring of 1882 she had an attack which made her 
swell all over. She was bed-ridden for nearly six months and 
that during this time her menstruation had ceased. She was 
nursing her child a part of this time. In 1883, 1884, 1885 
and 1886, she had similar attacks, each one of which lasted an 
average of three weeks. 
In the early part of April, 1887, I was called to see Mrs. 
S by Dr. H. F. Hendrix, of St. Louis. When I arrived at 
the house I found the patient in a high fever, the extremities 
somewhat oedematous, as also the face, and the entire body 
covered by an eruption which somewhat simulated erythema 
multiforme. The face presented a very peculiar appearance 
which was exaggerated by the oedema which was present 
The eruption consisted of large patches of circular contour 
and of variegated colors, but a brown color predominating. 
There was some headache. Burning and itching of the skin, 
together with more or less hypersesthesia of the lesions, ex- 
isted to a marked degree at times and at others it was not 
nearly so severe. The itching was easily relieved by scratching. 
The administration of quinine internally and of a soothing 
ointment externally relieved the patient in a few days and 
cut short an attack which usually lasted between two and 
three weeks. 
A few days later she called to my office and gave me the 
history which I have detailed above and afforded me some in- 
formation concerning her condition. The woman was 5 feet 
3 inches in height, weighed 125 pounds and had brown eyes 
and brown hair, the latter being in profusion. Her general 3 
appearance was that of slight emaciation. She stated that her 
general health was good once more, her appetite fair and that 
she slept well. Her menstruation had been normal and was 
still so. The object of her call was to consult me concerning 
her face. 
The following were the objective symptoms which she 
presented: The skin of the face was normal in color. It 
felt velvety and rather dry. It was considerably thickened, 
especially about the lobes of the ears. The nose was broader 
than normal, and a number of thick folds existed. The upper 
Fig. 1. Mrs. S-, setat. 19. 
lip was considerably thickened. (See Figs. 33 and 34.) The 
hands and feet were also involved in a similar manner, the 
body and limbs being apparently normal; at least, the skin 
presented nothing abnormal in appearance. 
The patient stated that since her marriage or rather after 
the first attack which she experienced, she became " nervous," 
a condition which had never existed previously. She had, 
since then, nervous spells at and during her menstrual periods. 
I saw her in that state and it appeared to me to be hysterical 
in nature. Besides this, anaesthesia was present. The face, 
neck, ears and a portion of the scalp were anaesthetic. I 
tested this by driving in a needle and the patient did not even 
know that anything was being done. In addition to this the 4 
entire area supplied by each ulnar nerve was anaesthetic as 
well as the dorsum of each foot. This condition had existed 
since 1883; but was not so pronounced at that time. I 
learned that the woman, in attending to her household duties, 
often burned her hands severely, but she was never conscious 
of the fact save objectively. When she saw the burn, she 
would then recognize the fact. 
I instituted some local treatment and expected to give 
Unna's treatment of leprosy a trial, as I had fully made up 
my mind that it was a case of this character. I saw her 
Fig. 2. Mrs. S-, aetat. 25. 
occasionally at the office until after an absence of about two 
weeks I was called to see her on June 26th. She was once 
more in bed suffering from slight fever and diarrhoea. On the 
29th she died. The diarrhoea was of that uncontrollable form 
occurring in the course of leprosy and which so often causes 
death in such cases. Although I tried my utmost I was 
unable to obtain a post-mortem examination. 
During the entire illness of this patient I was careful to 
recommend more or less isolation. Her child and her hus- 
band were not to sleep in the same bed nor were her dejecta, 5 
clothing or bed-clothing to be handled before thorough dis- 
infection by means of a one to a thousand solution of corrosive 
sublimate. This measure I adopted in view of the prevail- 
ing idea, among a large number of physicians, who claim that 
leprosy is a contagious disease, a claim which has never been 
successfully established and which is based upon data which 
are entirely insufficient. 
The question as to whether leprosy is contagious is one of 
great importance and one upon which much has been written. 
That the arguments derived from clinical observation alone 
have not been satisfactory is fully evidenced by the fact that 
neither side of the question has yet made converts to the 
views of the other. Personally I do not regard leprosy 
contagious, any more so than syphilis or phthisis and on ac- 
count of the same reasons. 
On the other hand there is no doubt, whatever, that it is 
an infectious disease ; that it is inoculable and that its effects 
are almost sure to follow an inoculation, that is properly 
made. 
The labors of the pathologists of late years have demon- 
strated most conclusively that leprosy is a disease dependent 
upon a micro-organism. This organism is the bacillus of 
leprosy and, unless it be introduced in the human organism, 
leprosy will not be produced. Now, for this purpose, two 
conditions are necessary. In the first place, the leper must 
have some solution of continuity of texture present in order 
to give free outlet to the bacilli as these organisms are situated 
in the tissues. In the second place, the individual who is to 
be the subject of leprosy must have some solution of con- 
tinuity of tissues in order to admit the bacilli, otherwise he 
cannot acquire the disease. This being the case, it is not 
difficult to understand how the disease may have been trans- 
mitted in some cases and not in others. But to argue that it 
is contagious and to such a degree as to require isolation, is 
not logical, if we carefully examine the premises. That the 
isolation of lepers practically stamped out the disease in 
Europe is true ; and that where it is endemic such measures 
should be pursued is equally true. But, in isolated cases, all 
that is necessary is to exercise a careful supervision and to 
give full directions to those surrounding the patient, in regard 6 
to contact and proper disinfection. Moreover, in my mind, 
there is never any danger until ulceration or some other similar 
feature appears. 
In the case which I have detailed above, the patient had 
burned her hand a number of times previous to my seeing her, 
and the ulcers which resulted might have proven foci of in- 
fection but apparently did not do so. I saw but one burn of 
this character and it healed kindly under the application of a 
corrosive sublimate dressing, which the patient was particular- 
ly enjoined to burn at each new application, the secretions to be 
removed by means of dry cotton and this immediately burned. 
Although I took these precautions I did not entertain any 
hopes of averting inoculation, except in regard to the future. 
The patient had the disease for several years ; it had remained 
unrecognized for so long a time that the chances of inoculating 
others had existed. But when we consider the probabilities 
in favor of this, they amost sink to nil. I entertain no fear 
that either her household or her child will ever show the 
presence of leprosy in their organisms. 
These two have disappeared from St. Louis and I have 
been unable to trace them to their new home. I will, how- 
ever, prosecute my search in order to have them kept under 
observation. Should they develop any traces of leprosy, they 
should be carefully watched, in order to prevent any further 
inoculation. 
Is leprosy on the increase in this country ? It is evidently 
not. There are a number of imported cases of leprosy in this 
country, but the sporadic ones are few and far between. The 
leper community of Louisiana is almost a thing of the past 
and the disease in general does not seem to be obtaining any 
foothold in the United States. 
One of the problems in connection with my case was, how 
did she contract the disease ? 
The most careful questioning, the most rigid cross exam- 
ination did not elicit any fact pointing to her having come in 
contact with any person affected with the disease, or of her 
having handled any clothing belonging to a leper. She had 
not traveled in any locality where lepers are known to abide. 
It could hardly be possible that the disease should have arisen 
de novo ; so that, in the absence of better evidence upon this 
point, the question must be left in abeyance.