TREATMENT OF ESPUNDIA 



91 



often supervene, and the voice is weakened or even temporarily 

 lost. The digestive tract becomes upset from the constant escape 

 down the throat of the exudations from the ulceration, mixed with 

 saliva or food. A spreading of the nose due to the eating away 

 of the septum is a characteristic feature. Although in late stages 

 of the disease the entire surface of the palate and nasal cavities 

 is attacked, and the septum between the nostrils destroyed, the 

 bones are left intact, a feature which readily distinguishes a 

 Leishmanian ulcer from a syphilitic one. Usually the victim of 

 espundia, after long suffering, sometimes for 20 or 30 years, 

 succumbs to the disease from pure exhaustion and from poison- 

 ing by exuded liquids which are swallowed. 



Fig. 16. A case of espundia before and after treatment with tartar emetic. 



(After d'Utra e Silva.) 



Treatment and Prevention. — It was in connection with ulcers 

 caused by Leishmania americana that the curative action of 

 tartar emetic was first worked out by Vianna in the Instituto 

 Oswaldo Cruz at Rio de Janeiro. The treatment of espundia 

 with this drug, injected into the veins, has been thoroughly tried 

 out in the past two years with great success. Although the 

 mucous membrane ulcers do not yield to the treatment as readily 

 as do skin sores, yet they can be cured with persistent treatment, 

 even in cases in which the nose and throat had been infected for 

 several years. The tartar emetic is injected as a one to two per 

 cent solution, as for other Leishmanian diseases, five to ten cc. 



