222 chapter 26
Cause of deformities
When most people think of leprosy, they think of the severe deformities of the
advanced case: deep open sores (ulcers), clawed fingers, gradual loss of fingers and
toes, and eye damage leading to blindness. Actually, these deformities are not caused
directly by leprosy germs, but result from damaged nerves. Nerve damage causes 3
levels of problems, one leading to the next:
LEVEL 1: loss of feeling, of
sweating, and of strength
in certain muscles
Eyes
do not
blink
normally
leads
to
Hands
do not feel;
skin dry;
weakness
of fingers
and thumb
leads
to
LEVEL 2: injuries, joint
stiffness
eye
irritation
and
infection
LEVEL 3: progressive deep
infections with bone
destruction and loss of vision
leads
to
scarring
and
blindness
stiffness and contractures
of fingers and thumbs;
also burns
and injuries
leads
to
loss of bone
Feet
do not feel;
skin dry;
drop foot
leads
to
painless
sores and
injuries;
stiffness
leads
and to
contractures;
skin
cracks
loss of bone
often PREVENTABLE with
medical treatment of leprosy
before there is nerve damage
often PREVENTABLE with
protective eye and skin care
and exercise to keep full
movement of joints
often PREVENTABLE with
careful early treatment of
sores, burns, and infections
When there are level 1 problems, there is a lifelong danger of level 2 and 3 problems.
Because feeling has been lost, the person no longer protects herself automatically
against cuts, sores, thorns, and other injuries. And because they do not hurt, these
injuries are often neglected.
For example, if a person with normal feeling walks a long way and gets a blister, it hurts, so he stops
walking or limps.
But when a person
with leprosy gets
a blister, it does
not hurt.
So he keeps
walking until the
blister bursts and
becomes infected
Still without pain,
the infection gets
deeper and attacks
the bone.
In time the bone is
destroyed and the
foot becomes more
and more deformed.
Usually, leprosy bacilli cannot be found in these open sores. This is because the sores
are not caused by the bacilli. Instead, they are caused by pressure, injury, and secondary
infection.
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