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678 Treatment.— Scraping and caustics, including the actual cautery, have been freely employed; but, although some improvement may be effected by these means, new nodules almost invariably spring up in the resulting cicatrix. Until recently complete excision, where practicable, offered the best chance of permanent cure; of course, such a proceeding had to be undertaken before large areas and important passages had become involved.

Judging from its relatively superficial nature and close resemblance to lupus, it seemed probable that ulcerating granuloma might prove amenable to some form of radiotherapy. This is actually the case, and X-rays are now regularly and successfully employed in Madras in the treatment of the disease. Of 37 cases treated in this way in Madras Hospital in 1908 all proved successful within an average period of two months. In three of the cases which could be followed up there was no recurrence four months after their discharge.

Treatment by intravenous injections of tartar emetic, introduced by Aragua and Vianna in 1913, has proved remarkably successful. Improvement invariably sets in, and, although in a small proportion of cases relapse occurs, in the vast majority the cure is radical. The initial dose should be 5 c.c. of 1 -per-cent, solution in normal saline, cautiously increased to 10 or 12 c.c. given daily or every second day. At the same time the sore should be dressed twice daily with compresses soaked in the 1-per-cent. solution, diluted if necessary (de Souza Araujo). The tartar emetic solution may be combined with or supplemented by the X-rays.