Handbook of geographical and historical pathology. Vol. III. Ch. XXIII, Oriental boils and other sores / by August Hirsch ; translated from the second German edition by Charles Creighton.

  • Hirsch, August, 1817-1894.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: Handbook of geographical and historical pathology. Vol. III. Ch. XXIII, Oriental boils and other sores / by August Hirsch ; translated from the second German edition by Charles Creighton. Source: Wellcome Collection.

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    Mysian Olympus. In the same part of the world, we find that one region of Syria, and the great plain corresponding to the ancient Mesopotamiaf form very important centres of it. In the former it occurs chiefly in the northern dis¬ tricts of the basin of the Orontes between Kilim and Aleppo; whereas it would appear to be only occasional in the towns and villages to the west of Aleppo, such as Skanderoom, and those of the Lebanon, and altogether un¬ known among the bedouins and the population of the Kurdish Highlands. In Mesopotamia its area includes the whole plain between the Euphrates and the Tigris, from Diarbekir downwards through Orfu, Mosul and Bagdad as far as Bassora. Joining on to that is a not less inconsiderable area of the disease in Persia,2 where its headquarters are the central regions of Teheran, Kashan and Ispahan, while there is less of it in Hamadan j in the northern mountainous districts, as well as on the shores of the Caspian, it is quite unknown. Across the Persian frontier we find a small focus of it in the district of Elisabothpol belonging to the government of Tiflis.s Prom Central Asia I know of only one reference to the boil, namely, that it occurs in Tashkend and along the river Tchirtchik, where it bears the name of “ sarten ;JH but it is not improbable that it is indigenous in other parts of Turk¬ estan, as well as in Afghanistan and Beluchistan, from which countries, we hear hardly anything about disease at all. That conjecture is all the more warranted, for Afghanistan at least, because one of the most important endemic areas of the boil is in Indian territory close to the Afghan frontier,5 extending along the Indus from the Punjaub (Lahore, Mooltan). southwards through Sind, (it would even seem as far.as Gujerat and the Gulf of Cambay), and eastwards through Rajpootana and the North-West Provinces as far as Delhi, 1 See the papers by Estlenne, Drlant, Guilhou, Griffiths, Floyd, Rafalowitsch, Jolt, Zimpcl, Gröscliel, Guys, Edcr, Willemin, Ponty, Evatt, Wortabet, Schlira’ mcr, Thin. * Polak, Tholozan. 3 Reinhardt, Polak (1868), Liebau. 4 Tachercpninj Heiman. 5 Gibson, Balfour, Frazer, Chcvers, Fleming;, Smith, Aitken, Aleocfc, Candy,. Dickinson, Harley, Fayrcr, Fox, Lewis and Cunningham, Murray. ORIENTAL BOILS. Meerut, Lucknow, and Gwalior. Bengal proper, Madras, Central India, and the Bombay Presidency (excepting the places named) appear to be quite free from the malady. Nor am I acquainted with any writings from which wo might infer its existence in the East Indies,1 in Lower India, in China or in Polynesia. § 225. Sketch of the Symptoms and Morbid Anatomy. There are many discrepancies in the accounts given by observers of the type and clinical history of the boil; but there is a good deal of uniformity in the main lines of their picture of it, which may be sketched somewhat as follows: Clinical and anatomical characters.—Without any symptoms pre¬ monitory of a constitutional disease, the boil begins as a reddish spot on the skin, with a very slight degree of nodular thickening at first, and gradually attains the size of a pea or a bean; a zone of redness surrounds it, and there is much itching. After the boil has lasted some time, it may be several months, there begins to ooze from its surface a clear serous fluid, which dries to a crust; the latter is often of considerable thickness, adheres firmly to the skin, and is soon replaced if it should have been forcibly detached. Tbe substance of the nodule gradually falls into purulent disintegration; so that there develops underneath the crust a round ulcer from 2 to 5 centimetres (£ to 2 in.) in diameter. The edges of the ulcer are irregular and as if eaten out; the process often goes deep down among the cutaneous tissues; the floor is uneven or lumpy, with greyish wart-like excrescences springing from it, which often dissolve to grow afresh, and yield an intensely offensive pus, mostly of thin consistence; the pus spreads over tbe surface of the sore and hardens to a dense, firm, dark-coloured crust. Around the ulcer the skin is red; sometimes erysipelas develops, or lymphangitis, with inflammatory swelling of lymphatic glands. When the suppurating process has gone on for several weeks or months, the floor of the ulcer at length begins to show good granulations capped by whitish crusts ; these gradually fill up the defect of substance, and in due time cicatrisation is complete. The cicatrix, following the shape and depth of the ulcer, is of irregular circular form, either level with the skin or depressed, often pigmented or discoloured a uniform brown; it puckers towards a central point, like the scar left after a bad burn, so that, when the boil is on the face, disfigurements of the nose, cheek, and lower eyelid may result. Not unfrequently several boils develop, 1 The disease known in the Moluccas under the name of Amboina boil or pock docs not belong to the same class, but to yaws. See Yol. II, joj.