1560 



FRAMBCESIA TROPICA 



ulcerated lesions becoming phagedenic, and giving opportunity 

 to septicaemia and pyogenic processes to develop. Though fram- 

 boesia rarely terminates in death, its long duration and great con- 

 tagiousness render it a serious malady. The patients suffering 

 from it are unable to attend to their work. Epidemics of fram- 

 boesia, therefore, are of the greatest consequence on tea, sugar, and 

 other plantations, as they reduce the supply of labour. 



Treatment. — ^The most efficacious and quickest treatment is by 

 Ehrlich-Hata salvarsan or neo-salvarsan, while potassium iodide 

 and tartar emetic are fairly efficacious, and mercury practically 

 useless. Salvarsan and neo-salvarsan and their substitutes seem 

 to act in framboesia more quickly and more powerfully than in 

 any other spirochsetal and treponemal condition; in fact, in fram- 

 boesia the therapia sterilans magna in Ehrlich's meaning, by a 

 single dose, can at times be obtained. Salvarsan was first tried 

 with good results in experimental yaws by Nichols, and in 

 patients suffering from the disease by Strong in the Philippine 

 Islands, and Castellani in Ceylon, while Alston in the West Indies 

 made the interesting observation that the serum of patients treated 

 with salvarsan showed remarkable curative powers when injected 

 in framboesia patients. Recently the salvarsan treatment of fram- 

 boesia has become general, having been used with very good results 

 by De Gorge and Mouzels, Sabella, Born, and many others. The sal- 

 varsan treatment is especially efficacious in recent cases. Relapses, 

 however, occasionally occur. In very old cases with tertiary 

 lesions the treatment may fail. At the present time neo-salvarsan, 

 instead of salvarsan, is generally used. 



Mode of Administration and Dosage.— Neo-salvarsan and its 

 substitutes novarsenobenzol, neokharsivan, novoarsenobillon, and 

 to a certain extent galyl, are much more soluble than salvarsan 

 and its substitutes arsenobenzol, kharsivan, etc., and are therefore 

 used in practice in preference to salvarsan. Moreover, Castelli has 

 shown that the dosis tolerata of neo-salvarsan in infected rabbits is 

 nearly three times larger than for salvarsan, and that the dosis 

 sterilans is one-tenth of the dosis tolerata. 



The dosage of neo-salvarsan and most of its substitutes is, in 

 adults, 0-4 to 0-6 gramme, though larger doses up to i gramme have 

 been given v/ith impunity. The dosage is therefore approximately 

 0*01 gramme per kilogramme of weight ; in children half or one-third 

 doses should be given. The best method of administration is by 

 intravenous injection, and we have found Ravaut's method of 

 concentrated solutions very convenient, although we do not use 

 such highly concentrated solutions as does Ravaut, who recommends 

 dissolving neo-salvarsan in only i or 2 c.c. of water. We generally 

 dissolve 0-3 or 0-4 gramme of neo-salvarsan in 10 c.c. of sterile 

 distilled water or sterile physiological salt solution, and make the 

 intravenous injection, using a 10 c.c. syringe. 



The patient is made to lie down quietly on a couch or in bed. 

 The skin is painted with tr. iodi and the veins of the bend of the 



