TREA TMENT 



1665 



combined with hot baths, and, in nerve cases, with doses of strych- 

 nine, eV grain three times a day, which may gradually be increased. 

 After a length of time it is as well to make a slight break in the 

 treatment, to prevent toleration, and therefore Unna's ointment of 

 ichthyol, 5 per cent.; salicylic acid, 2 per cent.; and pyrogallol, 

 5 per cent., or some other ointment, maybe temporarily substituted. 

 But the Chaulmoogra oil must not be long discontinued, and must 

 be persisted in for two years or longer if any good is to be obtained. 



The oil may be given hypodermically, but is badly absorbed. 

 To facilitate its absorption Heiser has successfully combined it with 

 camphorated oil, and Mercado has combined the mixture with the 

 resorcin formula of Unna. Heiser's present formula is — 



Chaulmoogra oil . . . . 60 c.c. 

 Camphorated oil . . . . 60 , , 

 Resorcin . . . . . . grms. 4 



Mix and dissolve with the aid of heat on a water bath and then filter. 



The injections are made in the gluteal region, at weekly intervals, 

 in ascending doses, one to five or ten cubic centimetres. During 

 the treatment the patient takes a hot sodium bicarbonate bath 

 (2 per cent.) every other day. The results are fairly satisfactory. 

 Sodium Gynocardate. — Rogers recommends the intravenous in- 

 jections of sodium gynocardate, which is supplied in sterile vials by 

 Smith, Stanistreet and Co. in doses of yV grain and upwards. There 

 is a definite reaction, local and general, after the injection. He also 

 gives gynocardic acid and sodium gynocardate orally in 2 grain 

 pills after meals, or by subcutaneous injection. 



Neumann has advised the combination of salve and theonin with Chaul- 

 moogra, given either by the mouth or hypodermically, but the advantages 

 are doubtful, and Hollmann has recommended the use of eucalyptus oil in 

 conjunction with opia leaves [Jamhos malaccenois) or with Chaulmoogra oil. 



Sources of Chaulmoogra Oil. — According to Ghosh, true Chaulmoogra is 

 Taractogenes kurzii from Burma and Assam ; false Chaulmoogra is Gynocardia 

 odorata from Sikkim, Assam, and Chittagong; other Chaulmoogras are Asteri- 

 astigma macrocarpa, Hydnocarpus venenatus, H. wigjitianus, H. anthclminticus . 

 The oil known in Europe as Chaulmoogra is said never to come from G. odorata. 



Cod-liver Oil and Sodium Morrhuate. — Cod-liver oil is occasionally 

 beneficial. Rogers recommends an intramuscular injection (i to 3 c.c.) 

 every other day of a 3 per cent, solution of sodium morrhuate. 



Other remedies are legion — e.g., X rays have been well spoken 

 of, but must be pushed to the extent of almost burning the patient. 

 A lo-inch spark-coil with a bifocal tube, situate 7 to 10 inches 

 from the lesion, has been used. Hypodermic injections of per- 

 chloride of mercury, as advocated by Crocker (o-oi gramme every 

 other day), have been found satisfactory at times — a treatment 

 which we recommend in cases at the very beginning of the disease. 



Cashew nuts (Beauperthuy treatment) have been applied to the lepromata 

 with the idea of local caustic action. Thyroid gland, salol, salicylates, arsenic, 

 Gurjun oil, chlorate of potash, iodine, hypodermic injections of iodoform, 

 have all been tried and found wanting. 



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