520 The Philippine Journal of Science 1923 



With the plain esters (Groups I and II), local effects are 

 manifested by moderate pain and swelling at the site of injec- 

 tions with more or less induration; the general well-being of 

 the patient is seldom if ever affected. With the creosote solu- 

 tions (Groups III and IV), the effects occur not only more fre- 

 quently, but also with a greater degree of severity. The 

 inflammation is more extensive, pain is more severe, and some- 

 times the temperature rises to as high as 37.9° C. Thus, 

 though the incidence rates in Groups II and III are approxi- 

 mately the same, the reactions in the latter group were more 

 severe. This is the chief reason why the average doses were not 

 as large as those of the pure ester. 



Chaulmoogra ethyl ester is itself a local irritant, but combined 

 with creosote it appears that its irritating effects are distinctly 

 increased. Camphor, somehow or other, seems very consider- 

 ably to reduce irritation. The more irritating character of the 

 creosoted drug is not a serious drawback for the reason that the 

 susceptibility of patients to this irritation is more marked at the 

 beginning of treatment; it tends to disappear, gradually but en- 

 tirely, m the course of treatment, so that after a time it causes 

 induration no more frequently than does the plain drug. 



Abscess formation at the site of injection is an unusual oc- 

 currence. In the series of one of us (Samson) this has been 

 observed once in Group I, four times in two patients in Group 

 II, twice m each, and once in Group IV. All were examined 

 bactenologically and found to be sterile. The other of us (Lim- 

 kako) has not had any abscess in this series. 



CHOKING AND COUGHING 



Choking is a phenomenon not infrequently observed a few 

 minutes after injections of chaulmoogra derivatives. It is man- 

 ifested by paroxysmal cough with flushing of the face, perspira- 

 tion, at times dizziness, and slight irritation of the pharyngeal 

 wails Just how it is produced has not been absolutely proven, 

 though it is held to be probably due to accidental rapid intro- 

 duction of the drug into the circulation. In this connection, 

 it may be remarked that patients with choking complain of 

 creosote taste and creosote odor of the breath. While it may 

 not be important, the relative frequency of this incident in the 

 different groups of our series is of interest. 



in Group I it occurred three times in three patients; in Group 

 II, four times 11, four patients; in Group III, twelve times in 

 eleven patients; and in Group IV, fifteen times in eleven patients; 



