EEVIEW — TROPICAL MEDICINE, ETC. 141 



He speaks to the morphological identity of the parasite of Oriental sore and that of Oriental 

 kala-azar, and, in order to see if they were specifically identical, he attempted to inoculate a Sore — 

 kald-azar patient from a case of Oriental sore. Unfortunately both the test inocuLitioii and contimied 



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 

 tlie disease might be due to a spirocha3ta, 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 wh-n 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 iumiediately 

 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 ii-regular, 

 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 

 bandcige : 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 lielps the cure. 



Donovan^ suggests that the itch insect, Sarcnptes scabiei, may be a vector, as he noticed 

 several sufferers from Oriental sore covered with itch. 



The parasite was first seen by Cunningham, but was rediscovered and described by 

 Wriglit, who named it Helcosoma tropicum. His description, method of staining and account 

 of its histology will be found in quotations given in the ludlan 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 chaudoyei 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 anaesthesia. In those cases where this is not feasible he thoroughly 



> Cox, W. H. (February, 1904), "The Baghd.ad Boil." Indian, itedical Gazette, Vol. XXXIX. 



■' Donovan, C. (March, 1904), " Delhi Boil." Tiulian Medical Gazette, Vol. XXXIX. 



» Billet, A. a R. Soc. Biol., t. LX., p. 1149. 



* Marzinowskv, E. .1. (December •24th, 1907), " Die Orient-beulen und ihro Aetiologie." Zrit. fiii- Hug. iind 

 Infekt., Bd. LVIIl"., No. 2. 



* Article not consulted in the original. 



