Clofazimine (Lamprene, B663) in the treatment of lepromatous leprosy in the United Kingdom. A 12 year review of 31 cases, 1966-1978.

This paper records the results of treatment with clofazimine of a group of 31 patients of mixed racial origin in the United Kingdom suffering from lepromatous or borderline-lepromatous leprosy. Progress was assessed by clinical and histopathological examination for periods up to 12 years after starting treatment. Although given mainly for dapsone resistance, either proven on mouse foot pad inoculation or strongly suspected on clinical grounds, clofazimine was also used in some patients for the suppression of reactions, notably those due to the formation of immune-complexes, the manifestations of which included erythema nodosum leprosum (ENL). Four patients, all of whom had taken clofazimine in relatively high dosage for many months, usually for ENL, complained about pigmentation. in the remaining patients, on doses of the order of 100 mg three times weekly, pigmentation was not a problem. None of the 31 patients suffered from gastro-intestinal symptoms or signs of any significance during the period of study. Many of the patients started taking dapsone in the 1940s; most had a long, complex, and unsatisfactory history of previous treatment with many drugs. This made assessment of response to clofazimine difficult in some cases. The general impression is that clofazimine has been outstandingly valuable both as regards treatment of the bacillary infection and the suppression of reaction. No patient relapsed during the period of study. The authors express the opinion that no other drug currently available for the treatment of leprosy could have achieved such good results in a comparable group of patients.

The contribution of medical missionaries to tropical medicine. Service-training-research.

Medical missionaries, historically the pioneers in introducing Western medicine into many tropical countries, are today responsible for a significant proportion of health care in several of those countries. Illustrating his theme with references to personal experiences in the former Belgian Congo, the author enlarges on the organization of a church-related comprehensive health care programme based on a chain of rural health centres and satellite dispensaries that brought curative and preventive medicine to the whole population within the area covered. Trypanosomiasis was eradicated, yaws and tuberculosis controlled, cerebral malaria eliminated, worm-loads reduced and nutrition improved. Leprosy was treated within the integrated service as soon as the sulphones became available. Medical auxiliaries and nurse-midwives were trained practically to tackle the local problems. Students from many missions over a wide area went into government, mission and company employ after training. Research concentrated mainly on the solution of pressing local problems, such as onchocerciasis and leprosy, but incidentally investigated interesting clinical phenomena.