2188 



ULCERATIONS 



formation of the greyish, dirty secretion. The ulcer will then 

 appear clean and of a pinkish colour ; but whatever be the further 

 treatment used, whether powders (iodoform, boracic acid) or 

 disinfecting ointments (white, red precipitate, or iodoform oint- 

 ments), the improvement will be very slow, and several weeks, and 

 often months, will elapse before a firm cicatrix is formed. Much 

 quicker results will be obtained by using a protargol ointment. 

 The ulcer is cleaned every morning with a perchloride lotion (i in 

 1,000) ; then a protargol ointment (5 to 10 or 20 per cent.) is thickly 

 spread on a piece of lint or gauze and applied to the ulcer, which 

 is then fairly firmly bandaged. 



The superiority of the protargol treatment over other kinds of local treatment 

 is patent in many cases. Castellani, who introduced it for ulcus tropicum, 

 niade the following experiment: in a patient presenting two ulcers of little 

 difference in size and deepness, one on the right leg, one on the left, he treated 

 the one on the right leg, which was slightly larger and deeper, with protargol, 

 and the one on the left leg with iodoform. The ulcer treated with protargol 

 healed in three weeks, the one treated with iodoform in two months. 



A silver nitrate ointment (| per cent.), or a silver nitrate [\ per cent.), 

 balsam of Peru (2 per cent.), ointment may also be used. 



To accelerate cicatrization allantoin preparations have been used, and 

 also scharUchroth powder. Salvarsan has been used locally as a powder, 

 but this method is not advisable, as it induces a very severe, painful inflam- 

 mation. Boigey and Vincent recommend a powder consisting of 10 parts of 

 fresh hypochlorite of soda and 90 parts of boric acid. 



ULCUS INTERDIGITALE. 



This affection is not rare among natives. It was described in 1909 

 by Castellani, whose work has been recently confirmed by_Breinl, 

 Martinez and Lopez. The patient complains of some itching 

 between the toes, though no papules or vesicles are seen. After a 

 few days a fissure appears, which rapidly deepens, and enlarges into 

 a large oval ulcer with a dull, dark red fundus and sodden-looking 

 margins. There is practically no discharge whatever. The ulcer 

 is generally very painful. The skin surrounding the ulcers does 

 not show signs of inflammation. Under proper treatment the 

 ulcer heals in a few days. The patient must remain at rest, washing 

 the ulcer twice daily with a i per cent, carbolic lotion, followed by 

 dressing with a bismuth-boric jacid 'ointment : — 



Bismuthi subnitratis . . . . . . . . gr. xxx. 



Acidi borici . . . . . . . . . . gr. xv. 



Vaseline . . . . , . , . . . . , ^i. 



ULCUS INFANTUM. 



Historical and Geographical. — Under this name Castellani de- 

 scribed a rather rare ulcerative condition of the legs met with in 

 Ceylon among children, both native and European. His researches 

 have been confirmed by various observers, among whom Gabbi 

 and Sabella in Tripoli. The condition is found in Ceylon, India, 

 and North Africa. 



