SUPPLEMENT 629 



soft palate, gums and lips all may be attacked. The mucosa of the 

 nose is usually attacked and the cartilages become destroyed, produc- 

 ing great deformity. In bad cases the pharynx and larynx may 

 become infected. 



Till recently it was believed that treatment was of little use unless 

 the case could be investigated early. Escomel considered that if the 

 primary cutaneous lesion was excised or destroyed, further progress 

 of the disease was prevented. When lesions have appeared on the 

 mucosa of the mouth or nose, little could be done. The ulcers might 

 be cauterized and mild antiseptic mouth washes used. 



In 1913 Vianna, working in Brazil, introduced treatment by tartar 

 emetic, which is now becoming more widely known and proving 

 efficacious. Carini 1 (1914) applies it thus. Tartar emetic (that is, 

 potassium antimonyl tartrate) in i per cent, aqueous solution is intro- 

 duced slowly into a vein, such as the vein at the bend of the elbow, 

 in doses of 5 to 10 c.c. daily or on alternate days according to the 

 tolerance of the patient to the drug. Eighteen to forty injections 

 have been used. In some of the memoirs on the subject, the drug is 

 referred to as antimony tartrate. 



The course of the disease is chronic and may last for twenty to 

 thirty years, death usually resulting from some intercurrent disease. 



At present the actual transmitter of Espundia is not known with 

 certainty. Various sand-flies (Simulidae) have been suspected of 

 transmitting the disease, though so far proof is wanting. It has also 

 been suggested that the natural food sources of some Simulidae known 

 to bite man, namely, certain snakes 2 and lizards, 3 are possible 

 reservoirs of the disease. 



Prophylactic measures would seem to consist in the immediate 

 disinfection of insect bites by tincture of iodine, and by avoidance of 

 areas known to be infested with snakes and lizards, and insects that 

 prey on them and man indifferently. The destruction of the primary 

 lesion as soon as detected is essential, and the isolation of advanced 

 cases of the disease seems advisable. 



Y. SPIROCHJETOSES. 



A. Relapsing Fevers. 



The relapsing fevers of Europe and of America, due to Spirochceta 

 recurrentis and S. novyi (probably a race of S. recurrentis), present 

 much the same symptoms, which differ in some respects from those 



1 Bull. Soc. Path. Exot., vii, p. 277. 



2 Lindsay (1914), Trans. Soc. Trap. Med. and Hyg. , vii, p. 259. 



3 Sergent (Ed. and Et.), Lemaire and Senevet (1914), Bull. Soc. Path. Exot., vii, 

 P- 577- 



