224 TROPICAL MEDICINE AND HYGIENE 



rounded nucleus. There are no giant cells. There is 

 no tendency to caseation, necrosis, or suppuration, and 

 the epithelium is usually present over the growth, though 

 softened and thickened. 



Treatment. Mercury and potassium iodide in the 

 majority of cases have no effect. In a few, where the 

 tendency to natural cure is strong, large doses of iodides 

 seem to aid this tendency. 



Cleanliness and antiseptic dressing favour rather than 

 retard the growth. Escharotics, such as chloride of zinc 

 nitrate of mercury, and salicylic acid, are rarely effective ; 

 complete excision of the growth where that is possible 

 is highly satisfactory, but the dense fibrous tissue should 

 be excised as well. The raw surface left is always more 

 extensive than the growth removed. Where excision is 

 impossible, scraping and the use of escharotics may give 

 satisfactory results. 



Good results have been obtained by the use of the 

 Rontgen rays. In Dr. McLeod's case the use of these 

 rays converted the granulomatous tissue into a cheesy 

 mass, which was readily scraped away, and healing then 

 took place rapidly. 



Etiology The occurrence on the genitalia and the 

 different situations in the two sexes are strongly in favour 

 of the view that the disease is conveyed by venereal inter- 

 course ; it does not seem to be highly contagious, as there 

 are cases where the husband only is infected and the 

 wife escapes. 



Spirochaetes resembling S. pallida and S. refringens have 

 been described by Wise as occurring in these granulomata. 

 Oval bodies have been described in the deeper layers 

 of the granuloma, but their exact nature is unknown, and 

 it is doubtful if they have any causal relation to the 

 disease. 



