Leprosy in Panama 1

Am. J. Trop. Med., s1-16(3), 1936, pp. 353-369
Copyright © 1936 by American Journal of Tropical Medicine

Leprosy in Panama
First Thirty Years of Segregation 1
Ezra Hurwitz AND Hamilton H. Anderson2
From the Health Department of the Panama Canal, the Gorgas Memorial Laboratory, Panama, and the Pharmacological Laboratory and the Pacific Institute of Tropical Medicine, University of California Medical School, San Francisco, California


Since 1904, 320 leprous patients have been segregated in Panama, half of whom were born in the islands or in other countries of the Caribbean. Only three lepers gave the Canal Zone as their birthplace. All but four now resident at Palo Seco are mestizos or blacks. The average patient-per-day cost for domiciliary and medical care is $1.15 for an approximate yearly population of 100 during the past ten years. Only 33 children have been admitted to the colony during the 30-year period. More than half of the patients are engaged in gainful occupation, which tends to improve the general morale of the group. Fifteen arrested cases, now resident in the colony, prefer to remain because of their recently improved hygienic, dietetic, social and medical status. None of 17 originally uninfected individuals employed at the colony, for as long as 20 years, in some instances, show any evidence by laboratory or clinical tests of having acquired leprosy.

A leprosy board of three members reviews all new patients, after a complete examination in the isolation ward at Gorgas Hospital, Ancon, and also passes on arrested cases ready for parole. Forty-four patients have been paroled, 142 have died, 18 absconded, 18 were repatriated, and 12 were re-admitted to the colony since 1904. Tuberculosis and nephritis are the most common causes of death. The more frequent complications are secondary anemia, malaria, nephritis, and intestinal parasites. Serologic blood reactions were positive in 31 of the 108 patients now segregated. The average age of onset of the disease is 31 years according to patients' statements, the leper entering the colony 3.7 years later. The leprous years numbered 8.4, 6 of which were spent in the colony (based on the average of 140 patients now dead). The present group of 108 have averaged 9.84 leprous years to date.

In the past chaulmoogra esters were given intravenously and intramuscularly and mercurochrome was used for a short period intravenously. At present the esters are being continued intramuscularly in those patients who present themselves for treatment, and this group is being compared with another now receiving "chaulphosphate" by vein. Merthiolate was found to be unsatisfactory for clinical use by intravenous injection. Saline treated controls failed to show the improvement noted in the "chaulphosphate" treated group over a comparable period. Intestinal parasites found in lepers were treated specifically.

Other studies now proceeding at Palo Seco include an investigation of the level of unsaturated fatty acids and total lipids in the blood of patients at various stages of the disease who have received various amounts of chaulmoogra (unsaturated) fatty acids. Early "cutineural" leprosy (that is, mixed leprosy, the most common type at Palo Seco) and cases improving under chaulmoogra therapy exhibit lower unsaturation and higher total lipids in the blood than do patients who are quiescent or advancing.

Received November 22, 1935.

1 Through the courtesy and/or with the coöperation of Col. J. F. Siler, Dr. H. C. Clark, Dr. D. P. Curry, Dr. L. B. Bates, Col. O. G. Brown and Mr. Everett Jacob, and supported in part by Eli Lilly and Company, Indianapolis, Indiana.

2 With the technical assistance of (Mrs.) Jeanette Van D. Anderson, Dr. Carl Pfeutze and Mr. John Dove.