[5 leprosy cases in the 20th century in Switzerland]. / Fünf Leprafälle im 20. Jahrhundert in der Schweiz.

Leprosy had a great impact on everyday life during the Middle Ages, which is reflected in many works of art and also in some preserved buildings. Worldwide, leprosy is still an unsolved problem; this fact has led the World Health Organization to develop a specific strategy to fight the disease. For physicians in Europe, leprosy has lost its significance. In the archives of the Swiss Canton of Valais leprosy in the 20th century is documented by photographs and written records. It is deplorable to see how a young woman can become crippled, lose her eyesight and die within a couple of years. Probably a pocket of leprosy persisted since the Middle Ages in this remote mountain area. The limited contagiousness of the disease is astonishing, since only a few of the closest family members and inhabitants of the some house were infected, while others remained healthy. The social situation of these patients at the beginning of this century was pitiable. The federal laws on epidemics of 1886 did not mention leprosy, as no one seemed to believe in its existence in Switzerland. Even after the cases of leprosy in the Canton of Valais were revealed, the reaction of the political authorities was reserved. An engaged effort by the involved physicians was necessary to establish the appropriate hygienic measures. In the literature of the time there were regular reports of cases in people who emigrated from the endemic areas. Today, in Switzerland one case of leprosy is discovered per year; thus, leprosy is still a disease which physicians must cope with.

[Suspected adult-onset Still's disease: unexpected manifestation of leprosy]. / Vermeintlicher Morbus Still des Erwachsenen: unerwartete Manifestation einer Lepra.

A 23-year old male from Sri Lanka was admitted to hospital with symmetrical inflammatory peripheral polyarthritis, fever of 39 degrees C and poly-lymphadenopathy. At first we suspected adult onset Still's disease. The histological findings from axillary lymph node biopsy strongly suggested the diagnosis of leprosy, for which we had had little evidence thus far. Typical skin lesions were absent, skin smears were negative and neurological symptoms only became obvious much later when fever and arthritis had subsided under anti-inflammatory treatment. At this time a right ulnar palsy developed, with atrophy of the interosseous muscles and thickening of the ulnar nerves at both medial epicondyles. Fite-stains of a sural nerve biopsy confirmed the diagnosis when mycobacteria were detected. Leprosy displays a clinico-pathological spectrum caused by variations in host resistance. A widely accepted classification is the five group system of Ridley and Jopling. At one extreme of this spectrum are patients with lepromatous or low resistance leprosy with numerous bacilli, and at the other those with high resistance or tuberculous leprosy where few or no bacilli are found. The numerous bacilli in the sural nerve biopsy classified the disease as lepromatous in our case. Of the various manifestations of the lepra reaction occurring in lepromatous leprosy, one is acute arthritis, but a more common one is erythema nodosum leprosum. Our patient's clinical presentation was interpreted to be a rheumatic manifestation of a type-2 reaction. This form of immunological response in leprosy is an immune complex syndrome and may mimic different rheumatic diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Results of surgical procedures for the correction of foot-drop and of lagophthalmus due to leprosy.

Leprosy mutilations of the muscles and skeleton can be relieved by reconstructive surgery, but evaluation of the results of these operations is seldom undertaken. Between 1975 and 1984, 59 leprosy patients were operated on at the Marie Adelaide Leprosy Centre, Karachi, Pakistan, for lagophthalmus with the transposition of the posterior tibial muscle. We were able to re-examine 39 patients: tibialis posterior transposition was performed 25 times, and temporalis transposition was carried out 33 times; 18 of the 25 patients with the tibialis posterior transposition were pleased with the result, 7 were not: 21 patients could extend their feet above the neutral position; 24 of the patients with the temporalis transposition were satisfied, 9 were not: complete closure was demonstrated in 21 eyes; Persistent corneal damage was noted in 15 eyes; 12 of the 23 male patients cared for themselves, 16 lived with their families; 7 of the 8 female patients lived with their families. The results of the rehabilitation, in relation to the degree of mutilation, are considered satisfactory for a developing country. These surgical procedures give a good result, provided they are followed by intensive physiotherapy.