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XI] Treatment.—— Some have advocated destruction of the primary papule, and even of the ulcer, by caustics or by the actual cautery; but a knowledge of the nature and natural progress of the disease suggests a protective and soothing rather than an irritating line of treatment. A dressing with some mild antiseptic ointment, as of iodoform, boric or salicylic acid, is indicated. Favourable results are reported from the application of an ointment consisting of equal parts of lanoline, vaseline, and methylene blue. Recently Row seems to have had prompt cures from hypodermic injections of killed cultures of the Leishmania parasite. The dose of a rich culture on N.N.N.medium, to which 5 drops of glycerine had been added forty minutes before, was ⅜ c.c. This may be repeated a few days later. Dr. Andrew Duncan informed me that in India he had seen these sores treated with great success by bandaging over them a piece of thin sheet-lead. Most probably these were not true oriental sores, which, as analogy would lead us to think, could heal only as the result of a specific treatment or on the establishment of immunity. X-ray and light treatment have been tried, with success in some cases, and unfavourable results in others. The reports on radium, salvarsan, and CO 2 snow treatment are decidedly favourable. These methods of treatment have been successfully superseded by antimony, given as in trypanosomiasis and kala-azar (p. 180). Tonics when the patient is anæmic or debilitated, attention to the general health, change of climate should the disease persist beyond the usual time, are indicated.

Under the terms espundia, bubas braziliana, uta, pian bois, etc., several writers Carini, Paranhos, Splendore, Escomel, and others have described a very grave form of leishmaniasis occurring in certain South American countries * —— Brazil, Bolivia, Peru,