ORIENTAL SORE 



2173 



2. The few eruptive elements — often one single element — situated 

 as a rule on uncovered parts of the body. 



3. The course: a small papule which slowly enlarges into an 

 indurated nodule, indolent, smooth, or slightly scaly, and after 

 several months ulcerates. 



4. The proximal lymphatic glands usually not enlarged. 



The history, the absence usually of enlarged lymphatic glands and 

 other symptoms of syphilis, and the uselessness of the mercurial 

 treatment, will help in excluding syphilis. In framboesia there is a 

 primary lesion, which, after a time, is followed by a general granu- 

 lomatous eruption. We have, however, seen cases of framboesia 

 patients who, after the general eruption has disappeared, have 

 remained for months with a single or a few sores closely resembling 

 the Oriental sore. In fact, we believe that in a certain number of 

 cases it is very difficult to make the differential diagnosis between 

 Oriental sore and ulcers of tubercular, syphilitic, or framboetic origin ; 

 also, at times, from cancroid when the ulcer is single and situated 

 on the face. In our experience, the only reliable way to come to a 

 definite diagnosis in difficult cases is the microscopical examination. 

 To do this the scab is removed, and a scraping is taken from the 

 floor and edges of the ulcer. The preparation is then coloured with 

 Leishman's or Giemsa's stain, or any other of the numerous modifi- 

 cations of Romanowsky's method, and examined for the presence of 

 Leishmania tropica. The search must be prolonged in some cases, 

 as the parasites may be very rare. 



Prognosis. — In the common type the prognosis is good, quoad 

 vitam. Very occasionally the disease may end fatally, owing to the 

 ulcers becoming phagedsenic, and to secondary septicaemic and 

 pysemic processes. In some rare cases, as observed by Cardamatis in 

 Greece and Lacava and Gabbi in Italy, the ulcerative lesions may 

 spread to the mucosa of the mouth. Sometimes the scars remaining 

 after the ulcers have healed up shrink considerably, and if they are 

 on the face, may give rise to serious disfigurement. 



Treatment. — Tartar emetic is a specific. It is best given by 

 intravenous injection, using a i per cent, solution in saline or simple 

 distilled water. The solution should not be autoclaved; it should 

 be filtered through a Berkefeld candle, or may be sterilized in flowing 

 steam on two or three consecutive days. Five to ten c.c. of the solution 

 are given daily for five to ten days, then every other day or twice a 

 week until fifteen to thirty injections have been given. In children 

 one-third or half doses are used. The intravenous injections should 

 be given, taking all ordinary precautions and making sure that the 

 needle is actually in the vein and that none of the liquid escapes into 

 the surrounding tissues. Soon after the injection patients at times 

 complain of metallic taste, giddiness, and nausea, but as a rule 

 tolerance for the drug is easily established. OccasionaUy a prolonged 

 treatment induces diarrhoea, and the patient may complain of 

 great debility and muscular stiffness. Tachycardia has been noticed, 

 exceptionally, and a few cases of sudden death have been ascribed 



