1564 



FRAMBCESIA TROPICA 



also very successful. Some cases may recover spontaneously, but this is 

 certainly the exception, not the rule. Occasionally cases are met with re- 

 fractory to any treatment, and tertiary lesions are often intractable. An 

 important point often overlooked by the practitioner is that the oral treatment 

 should be prolonged for a time after the complete disappearance of the erup- 

 tion, inasmuch as clinical experience, as well as experiments on inoculated 

 monkeys, prove that the specific treponemata may, and do, persist in the 

 lymphatic glands and internal organs long after the cutaneous manifestations 

 have disappeared. Atoxyl has been tried by Neisser in monkeys experi- 

 mentally inoculated with the disease, and by one of us in human patients. 

 The results are occasionally fairly good. Spittel has used, by intravenous 

 injection, a solution of arsenious and mercuric iodide. 



Local Treatment.— This consists chiefly in keeping the skin 

 scrupulously clean, washing the eruption twice daily with a per- 

 chloride of mercury solution (i to 1,000), which greatly allays the 

 itching. The ulcerated lesions may be dusted with iodoform, 

 europhen, xeroform, or boracic acid. Mercury ointments may be 

 beneficial, but in our experience are not sufficient to hinder secon- 

 dary pyogenic infections. Caustics are not called for unless the 

 ulcers become phagedenic. In such cases pure carbolic acid is best. 

 Though the external treatment may be useful, one must bear in 

 mind that it is not, as a rule, sufficient alone to cure the disease. 



Prophylaxis. — In countries where framboesia is endemic the 

 slightest abrasions of the skin should be taken care of and properly 

 treated with antiseptics. Framboesia patients should be prevented 

 from mixing with the rest of the population, and should be isolated 

 in special hospitals till the disease is cured. Their skin lesions should 

 be properly dressed, and thus prevented from becoming a source 

 of infection through the agency of flies and other insects. Their 

 huts and belongings should be thoroughly disinfected. 



REFERENCES. 



Alston (191 1). British Medical Journal. London. 



AsHBURNE AND Craig (1907). Philippine Journal of Science, B. Manila. 



Bahr (1915). Ann. Trop. Med. and Parasit. 



Barret (1905). Pathological Society of London, November. 



Blanchard (1906). Arch, de Parasitologic. Paris. 



Borne {1906). Geneeskundig Tijdschrift. 



Branch (1906). Journal of Tropical Medicine. London. 



Breda (1906). Giornale d. mal. ven. e d. Pelle. 



Brochard (191 3). Bull. Path. Exot. 



Brcertjes (1917). Salvarsan bij framboesia tropica. Geneesk. Tiidschr. 



V. Nederl.-Indie. 

 Casoni (191 5). Malaria e Mal. Paesi Caldi. 



Castellani (1905-17). Ceylon Medical Reports; Journal of the Ceylon 

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 August, 1905; British Medical Journal, November, 1905; Journal of 

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 Woch., January i, 1906; Journal of Cutaneous Diseases, igo8; Archiv 

 fiir Schifis- und Tropen-Hygienc, Bd. XL. 1907 and 1911. 



Castellani (1917). Transactions Society of Tropical Medicine, 1917. vol. x.. 

 No. 8, July. 



Castelli (1912). Zeitschrift fiir Chemoterapie. 

 Clemow (1903). Geography of Disease. London. 



