Leprosy among school children in Greater Bombay: clinical features.
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Biomedical subjects
Publications and source records attributed to S S Pandya.
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This paper summarises the experience gained through extensive surveys of school children carried out in Greater Bombay over the past five years. The strikingly high proportion of children of 6 to 14 years age group suffering from leprosy attending the Acworth Leprosy Hospital and its peripheral clinic prompted these surveys. While surveys of 10% of child population attending randomly selected municipal schools revealed a general prevalence rate of 3 per 1000, there existed pockets of endemicity of the order of 10.8 per 1000, in some schools situated in the northern suburbs of the city. Even private schools catering to the not-so-poor sections of the community showed prevalence rates of over 6 per 1000, confirming the hyperendemicity of leprosy in Bombay city, with no socioeconomic or age group immune from exposure. Clinical observations of 1265 leprosy cases identified in the course of the above surveys covering a total population of nearly 1.8 lakhs of school children are presented. 24.7% of the cases had either the potential to develop into progressive forms of leprosy in view of the multiplicity of lesions or were already in an advanced stage of the disease. Polyneuritic leprosy together with intermediate and lepromatous types representing 5.8% of all cases (24 cases were confirmed to be smear positive) belonged to the groups posing therapeutic as well as public health problems. Analysis of 953 cases with single lesions revealed greater frequency of distribution (58.4%) of patches in parts of the body which are generally covered. It is striking that 26.4% of the solitary lesions was found in the gluteal regions and thighs, emphasising the need for thorough examinations of these parts during surveys.
Sixteen cases with arthrogryposis multiplex congenita were examined clinically and electromyographically; three of them were re-examined later. Joint deformities were present in all extremities in 13 of the cases; in eight there was some degree of mental retardation. In two cases, there was clinical and electromyographic evidence of a myopathic disorder. In the majority, the appearances of the shoulder-neck region suggested a developmental defect. At the same time, selective weakness of muscles innervated by C5-C6 segments suggested a neuropathic disturbance. EMG revealed, in eight of 13 cases, clear evidence of denervation of muscles, but without any regenerative activity. The non-progressive nature of this disorder and capacity for improvement in muscle bulk and power suggest that denervation alone cannot explain the process. Re-examination of three patients after two to three years revealed persistence of the major deformities and muscle weakness noted earlier, with no appreciable deterioration.
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The present paper examines the first attempts to internationalise the problem of leprosy, a subject hitherto overlooked by historians of imperialism and disease. The last decade of the nineteenth century saw many in the civilised countries of the imperialist West gripped by a paranoia about an invasion of leprosy via germ-laden immigrants and returning expatriates who had acquired the infection in leprosy endemic colonial possessions. Such alarmists clamoured for the adoption of vigorous leper segregation policies in such colonies. But the contagiousness of leprosy did not go unquestioned by other westerners. The convocation in Berlin of the first international meeting on leprosy revealed the interplay of differing and sometimes incompatible views about the containment of leprosy by segregation. The roles of officials from several countries, as well as the roles of five protagonists (Albert Ashmead, Jules Goldschmidt, Edvard Ehlers. Armauer Hansen, and Phineas Abraham) in the shaping of the Berlin Conference are here examined.
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The pattern of extrafusal and intrafusal innervation was studied in muscle biopsies from the flexor carpi ulnaris and biceps brachii muscles, which were clinically unimpaired. Smudginess and enlargement of the motor end plates were the most definitely abnormal feature of the extrafusal innervation pattern; the intrafusal fibers, on the other hand, were either unremarkable or showed increased tortuosity, beading and in more extreme cases of grossly complicated intertwining pattern. Bacilli were frequently found in the spindles, no component being spared. The study emphasizes the significant involvement of striated muscle in leprosy, a fact not revealed by clinical examination alone.