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He speaks to the morphological identity of the parasite of Oriental sore and that of kala-azar, and, in order to see if they were specifically identical, he attempted to inoculate a kala-azar patient from a case of Oriental sore. Unfortunately both the test inoculation and the controls failed. Manson believes Oriental sore to be a blood disease, and that if it be cured in one place it will break out in another. If, however, the disease is obtained in the involution stage, pressure and local application may hasten the cure. Low thought the disease might be due to a spirochxta, while Duncan mentioned a case successfully treated by the application of a disc of lead the same size as the sore. Sambon mentioned the liability to recurrence and the outbreak of successive crops of a peculiar eruption after the appearance of the first sore. He also alluded to the fact that the disease, which was one of towns, occurred in dogs, and that in their sores the characteristic parasite existed. Hartigan mentioned that many of the Jews in Hong Kong suffered from the disease in unexposed parts, a fact which Manson explained, as far as the Jews in Baghdad went, by infection during childhood which was the time of life when the body was not generally covered in hot climates.
Fremantle regarded the condition as a local infection, not as a general disease. Manson, in reply, stated that as Duncan had applied the lead compress after five months’ ineffective treatment a cure might be expected as the disease was exhausted and inclined to heal
spontaneously.
Cox! has a good paper on the Baghdad boil which is a disease of cities or rather of streets which are not properly laid and scavenged. The only method of prevention is to disinfect or cauterise thoroughly any cut, wound, abrasion or mosquito bite immediately on its occurrence. He describes the minute papule increasing in size and finally becoming the ulcer of which there are two types, the male and female, so-called :—
(1) The male ulcer is oblong in shape, like a date seed, hence the name of “ date-mark,” with an irregular, undermined edge and indurated margin: it is tender on pressure, with a dry uneven surface, and it is extremely indolent in character. The ulcer either remains stationary in size or it gradually enlarges, sometimes attaining a diameter of two inches: as a rule, the size varies from that of a hazel-nut to an inch in the wider diameter. On reaching its permanent size, the sore retains its characteristic appearance and soon forms a dry pustular scab,
which increases in size in successive layers, until it becomes a nodular crust, when it drops off, leaving the raw surface of the ulcer bare, and then the scabbing starts afresh.
(2) The characteristics of the male ulcer apply also to the female ulcer, and the only difference is that the latter, instead of forming a dry scab, is forever discharging a pale yellow, watery pus, which adds to the distress
of the patient. Both kinds leave a permanent scar.
For treatment in the late stages he recommends strong sulphur ointment (20 per cent.) applied on resin plaster with a layer of wool on the top to graduate the pressure of the bandage: this is applied daily for four or five days until the surface of the ulcer looks clean. Then Unguentum Picis is applied until granulations appear. These are touched with blue stone and an ordinary dressing of boric ointment is applied. Healing occurs in from one to six weeks. Arsenic in medium doses helps the cure.
Donovan? suggests that the itch insect, Sarcoptes scabiet, may be a vector, as he noticed several sufferers from Oriental sore covered with itch.
The parasite was first seen by Cunningham, but was rediscevered and described by Wright, who named it Helcosoma tropicum. His description, method of staining and account of its histology will be found in quotations given in the Indian Medical Gazette of August, 1904,
and the Journal of Tropical Medicine, May 16th, 1904.
Billet?* found a case originating at Ismailia and presenting Wright’s parasite. He suggests that Anopheles chaudoyet may be the carrier, owing to its distribution, especially in
Algeria where ‘‘ Biskra boil” occurs. A recent paper by Marzinowsky* gives a very full bibliography and enters more minutely into the question of treatment than is usually the case. He mentions various caustics and astringents which can be employed followed by dusting powders and finally by sublimate wash, but, considering that the healed sore leaves a permanent scar, he is all in favour of operation under cocaine anesthesia. In those cases where this is not feasible he thoroughly
1 Cox, W. H. (February, 1904), “The Baghdad Boil.” Indian Medical Gazette, Vol. XXXIX.
2 Donovan, C. (March, 1904), “ Delhi Boil.” Indian Medical Gazette, Vol. XXXIX.
S Billet, A. C. R. Soc. Biol., t. LX., p. 1149.
+ Marzinowsky, E. J. (December 24th, 1907), “Die Orient-beulen und ihre Aetiologie.” Zeit. fiir Hyg. und Infekt., Bd. LVIII., No. 2.
* Article not consulted in the original.
Oriental Sore—
continued
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