multitude of numerous
methods
and
drugs, sufficiently
to demonstrate the unsettled state
of
knowledge as to the best treatment. In considering what method to adopt in any particular case, the number of sores, their position and the stage of the disease should be taken into consideration. Obviously the treatment of an early case of seven or eight small boil-like sores must be radically different from that of a single chronic ulcer, measuring possibly four squareour
inches in area commenced.
in which natural
healing
has
Excision.?This is only applicable to early when the sores are few in number, and not situated on the face. In two or three cases in which I have excised such sores and sutured the skin, primary union has occurred.
cases
Scraping.?This is, taken all round, the method of most general application. It is indicated when the sores are not situated on the face, and when ulceration is not very extensive. The scraping should be done thoroughly, special attention be paid to the edges, which should be The rendered flush with the surrounding skin. sores with carbolic then be swabbed pure may acid, and dressed with any moist antiseptic dressing. In the after-treatment, mercury
THE TREATMENT OF ORIENTAL SORE.
^By
g. g. jolly,
captain, I.M.S.,
During the past eighteen months I have had considerable number of cases of Oriental Sore under my treatment, and my experience may not be entirely without interest, more especially as most of the text-book descriptions of the treatment of this troublesome condition are scanty and unsatisfactory. a
Treatment
of
skin
disease
Local
may be
either
Applications.?Of
these the number is
legion. Caustics such as silver nitrate, copper sulphate, arsenious acid, nitric acid, ichtliyol, balsam of Peru, and a native preparation called rasout have all been tried by me with varying success, mainly dependant on the stage of the disease. When it is important to avoid scarring, it is sometimes of use to give one or other of these drugs a trial, and I have found the mercury ointments, and especially ammoniated mercury ointment the most satisfactory. Occasionally a superficial sore will heal up rapidly under this latter ointment with very little scarring. If inflamed the ulcer should, of course, be poulticed until the inflammation has subsided. In the early stage of the sore, before ulceration has advanced far, thorough swabbing with pure carbolic acid, followed by the application of iodoform powder occasionally induces rapid cure. In the majority of cases it is a mistake to spend "
Quelta.
J
ointments, especially unguentum hydrargyri ammoniati, appear to hasten healing and prevent relapse.
"
general or local. Manson, speaking of Oriental Sore, states that analogy would lead us to think that healing could only occur as the result of a specific treatment, or on the estabishment of immunity. This is not, however, in accordance with experience. It would appear from the results of treatment, that the infection should be regarded much time on this line of treatment, but when a as a purely local one as opposed to that of Kala- sore is too extensive to be scraped without great Azar, in spite of the morphological identity of the loss of tissue, and perhaps the necessity of two parasites. It is surely no more remarkable subsequent skin-grafting, one is justified in giving that Oriental Sore should be a purely local condi- local application of one or the other of these tion, whilst Kala-Azar is a general infection, than drugs a fair trial. that lupus vulgaris should be local and acute X-Rays.?The X-Ray is a useful adjunct in the miliary tuberculosis general. treatment of Oriental Sore. As a method of Local treatment is the only satisfactory line to treatment by itself it upon; but here one is faced with a appointing. A sore
proceed
is, however, rather to X-Rays as a
exposed
disrule
TREATMENT OF ORIENTAL SORE.
Dec., 1911.]
improvement after the first few It becomes cleaner, inflammation applications. subsides and with it pain, and the skin edges begin to grow in. This improvement unfortunately does not as a rule continue beyond a certain point, and in the majority of cases some other method has to be resorted to, to complete the cure. Frequently after-treatment with X-Kays the sore heals in parts, while pockets are left containing pus. These should be slit up if necessary, and swabbed with pure carbolic acid. The best results are obtained from X-Kays with superficial sores, and then healing is frequently rapid after a few exposures. In a large deeply-ulcerated sore, when the tissues are soft and friable, and scraping would mean the complete removal of all epithelium over a large area, X-Kays will often induce healing in patches, which gradually unite, leaving only two or three deeper places to be dealt with by other methods. Another indication for X-Kays in this disease is in the case of sores on the face, when the patient usually comes for treatment early, and where it is important Otherwise when scraping to avoid scarring. be done it is the more rapid and surer can method. shows marked
Carbon Dioxide Snow.?This is a recent method which is still in the experimental stage. An interesting note upon it was given by Captain H. H. Broome, I.M.S., in the I. M. G. of April, 1911. I have tried the method in some ten or twelve cases in various stages, and have not found Tn these cases after it to be superior to scraping. snow for from of the application thirty seconds to one minute, the superficial portion of the sore
gradually separated leaving
a
fairly clean, deeply
hollowed out ulcer, which took quite as long to heal as the ulcer left after scraping. The method has of course this advantage that no anaesthetic is required.
Prophylaxis.?Until
infection
are
more
the methods
thoroughly
or
method of
investigated
must of necessity be somewhat experimental. The disease has been proved to be inoculable and auto-inoculable, the discharge has been shown to be infective, and as pointed out by row, it is probable that infection is commonly carried by house flies on their feet and probosces, and possibly also in their excreta. The alighting of an infected fly upon a small abrasion thus constitutes an exposure to infection. This being so, preventive measures should include personal cleanliness to prevent auto-inoculation, treatment and careful covering of all wounds and skin abrasions and of the sores themselves, and lastly, exclusion and destruction of flies and their breeding places. In view of the possibility of an alternative method of infection through the bites of biting insects, I recommend the substitution of iron bedsteads for wooden charpoys, the use of
prophylaxis
467
and the cauterising of all insect bites with lunar caustic or some similar preparation, as measures which it may be worth while to adopt in endemic areas.
mosquito curtains,
methods
and
drugs, sufficiently
to demonstrate the unsettled state
of
knowledge as to the best treatment. In considering what method to adopt in any particular case, the number of sores, their position and the stage of the disease should be taken into consideration. Obviously the treatment of an early case of seven or eight small boil-like sores must be radically different from that of a single chronic ulcer, measuring possibly four squareour
inches in area commenced.
in which natural
healing
has
Excision.?This is only applicable to early when the sores are few in number, and not situated on the face. In two or three cases in which I have excised such sores and sutured the skin, primary union has occurred.
cases
Scraping.?This is, taken all round, the method of most general application. It is indicated when the sores are not situated on the face, and when ulceration is not very extensive. The scraping should be done thoroughly, special attention be paid to the edges, which should be The rendered flush with the surrounding skin. sores with carbolic then be swabbed pure may acid, and dressed with any moist antiseptic dressing. In the after-treatment, mercury
THE TREATMENT OF ORIENTAL SORE.
^By
g. g. jolly,
captain, I.M.S.,
During the past eighteen months I have had considerable number of cases of Oriental Sore under my treatment, and my experience may not be entirely without interest, more especially as most of the text-book descriptions of the treatment of this troublesome condition are scanty and unsatisfactory. a
Treatment
of
skin
disease
Local
may be
either
Applications.?Of
these the number is
legion. Caustics such as silver nitrate, copper sulphate, arsenious acid, nitric acid, ichtliyol, balsam of Peru, and a native preparation called rasout have all been tried by me with varying success, mainly dependant on the stage of the disease. When it is important to avoid scarring, it is sometimes of use to give one or other of these drugs a trial, and I have found the mercury ointments, and especially ammoniated mercury ointment the most satisfactory. Occasionally a superficial sore will heal up rapidly under this latter ointment with very little scarring. If inflamed the ulcer should, of course, be poulticed until the inflammation has subsided. In the early stage of the sore, before ulceration has advanced far, thorough swabbing with pure carbolic acid, followed by the application of iodoform powder occasionally induces rapid cure. In the majority of cases it is a mistake to spend "
Quelta.
J
ointments, especially unguentum hydrargyri ammoniati, appear to hasten healing and prevent relapse.
"
general or local. Manson, speaking of Oriental Sore, states that analogy would lead us to think that healing could only occur as the result of a specific treatment, or on the estabishment of immunity. This is not, however, in accordance with experience. It would appear from the results of treatment, that the infection should be regarded much time on this line of treatment, but when a as a purely local one as opposed to that of Kala- sore is too extensive to be scraped without great Azar, in spite of the morphological identity of the loss of tissue, and perhaps the necessity of two parasites. It is surely no more remarkable subsequent skin-grafting, one is justified in giving that Oriental Sore should be a purely local condi- local application of one or the other of these tion, whilst Kala-Azar is a general infection, than drugs a fair trial. that lupus vulgaris should be local and acute X-Rays.?The X-Ray is a useful adjunct in the miliary tuberculosis general. treatment of Oriental Sore. As a method of Local treatment is the only satisfactory line to treatment by itself it upon; but here one is faced with a appointing. A sore
proceed
is, however, rather to X-Rays as a
exposed
disrule
TREATMENT OF ORIENTAL SORE.
Dec., 1911.]
improvement after the first few It becomes cleaner, inflammation applications. subsides and with it pain, and the skin edges begin to grow in. This improvement unfortunately does not as a rule continue beyond a certain point, and in the majority of cases some other method has to be resorted to, to complete the cure. Frequently after-treatment with X-Kays the sore heals in parts, while pockets are left containing pus. These should be slit up if necessary, and swabbed with pure carbolic acid. The best results are obtained from X-Kays with superficial sores, and then healing is frequently rapid after a few exposures. In a large deeply-ulcerated sore, when the tissues are soft and friable, and scraping would mean the complete removal of all epithelium over a large area, X-Kays will often induce healing in patches, which gradually unite, leaving only two or three deeper places to be dealt with by other methods. Another indication for X-Kays in this disease is in the case of sores on the face, when the patient usually comes for treatment early, and where it is important Otherwise when scraping to avoid scarring. be done it is the more rapid and surer can method. shows marked
Carbon Dioxide Snow.?This is a recent method which is still in the experimental stage. An interesting note upon it was given by Captain H. H. Broome, I.M.S., in the I. M. G. of April, 1911. I have tried the method in some ten or twelve cases in various stages, and have not found Tn these cases after it to be superior to scraping. snow for from of the application thirty seconds to one minute, the superficial portion of the sore
gradually separated leaving
a
fairly clean, deeply
hollowed out ulcer, which took quite as long to heal as the ulcer left after scraping. The method has of course this advantage that no anaesthetic is required.
Prophylaxis.?Until
infection
are
more
the methods
thoroughly
or
method of
investigated
must of necessity be somewhat experimental. The disease has been proved to be inoculable and auto-inoculable, the discharge has been shown to be infective, and as pointed out by row, it is probable that infection is commonly carried by house flies on their feet and probosces, and possibly also in their excreta. The alighting of an infected fly upon a small abrasion thus constitutes an exposure to infection. This being so, preventive measures should include personal cleanliness to prevent auto-inoculation, treatment and careful covering of all wounds and skin abrasions and of the sores themselves, and lastly, exclusion and destruction of flies and their breeding places. In view of the possibility of an alternative method of infection through the bites of biting insects, I recommend the substitution of iron bedsteads for wooden charpoys, the use of
prophylaxis
467
and the cauterising of all insect bites with lunar caustic or some similar preparation, as measures which it may be worth while to adopt in endemic areas.
mosquito curtains,
