2196 



ULCERA TIONS 



absence of the secondary eruption and the inefficacy of mercurial 

 treatment. Lupus is very rare in such situations, and in epithehoma 

 the lymphatic glands would be eatly infected. In doubtful cases 

 microscopical examination of a piece of the diseased tissue will 

 enable the diagnosis to be made from lupus as well as from 

 epithehoma. 



Prognosis. — The disease as a rule does not affect the general 

 health, but is extremely chronic, lasting for years. 



Treatment. — Tartar emetic, though not efficacious in every case, 

 should always be given a thorough trial. The treatment is carried 

 out in the same way as for cutaneous leishmaniasis (see p. 2173). 



Tartar emetic was first used in granuloma inguinale in 191 3 by Arago, 

 Vianna, and De Souza Araujo. Breinl and Priestley confirmed the work of 

 these observers in a case in Australia, and very shortly after Newham ar,d 

 Low in a case in Europe. Low, however, reported later on a complete failure 

 of the tartar emetic treatment in another case. 



Greig and Curjel consider that tartar emetic benefits the condition onl}- 

 when given in very large doses; according to them the drug acts, not as a true 

 specific, but as a general protoplasmic poison. 



The best local treatment is radiotherapy with X rays, which has been found 

 quite successful in Madras. If these are not available, antiseptic lotions should 

 be applied, and then portions excised, or the diseased areas may be scraped 

 and then cauterized. Conyers and Daniels recommend the application of 

 an ointment of salicylic acid (gr. xxx.), unguentum creosoti (§i.). 



Certain observers claim to have had good results with salvarsan and neo- 

 salvarsan. The technique of the treatment has been described in the chapter 

 on Framboe^ia (p. 1 560) . Large doses of potassium iodide are said to be useful . 



PAPILLOMA INGUINALE TROPICUM. 



Synonym. — Acanthoma Inguinale (Castellani). 



A pecuhar papillomatous affection of the inguinal regions is not 

 rare among Tamils. Further experience will probably show that 

 other races are also affected. Women are apparently more liable 

 to the disease than men, inasmuch as, although the number of male 

 patients in the Colombo Clinic and hospitals is much larger than 

 the number of female patients, not a single case has been detected 

 among men. 



Symptomatology. — One or both inguinal regions are occupied by 

 extremely numerous tall filiform vegetations of a pinkish or darkish 

 colour. No ulcerative lesions are present. There is neither pain 

 nor pruritus. The general health does not seem to be affected. The 

 affection is very chronic, and is probably contagious, but nothing 

 is known of the aetiology. In the cases so far observed the genital 

 organs of the patient were normal, and there was no history of 

 gonorrhoea or any other venereal disease. 



Treatment. — The treatment is surgical — removal of the vegeta- 

 tion by the knife and cauterization. The patient, as a rule, how- 

 ever, will not consent to the operation. 



