Fig. 32.—Mycetoma, or Madura Foot.
(Museum of Royal College of Surgeons, Edinburgh.)
Delhi Boil.—Synonyms—Aleppo boil, Biskra button, Furunculus orientalis, Natal sore.
Delhi boil is a chronic inflammatory disease, most commonly met with in India, especially towards the end of the wet season. The disease occurs oftenest on the face, and is believed to be due to an organism, although this has not been demonstrated. The infection is supposed to be conveyed through water used for washing, or by the bites of insects.
Clinical Features.—A red spot, resembling the mark of a mosquito bite, appears on the affected part, and is attended with itching. After becoming papular and increasing to the size of a pea, desquamation takes place, leaving a dull-red surface, over which in the course of several weeks there develops a series of small yellowish-white spots, from which serum exudes, and, drying, forms a thick scab. Under this scab the skin ulcerates, leaving small oval sores with sharply bevelled edges, and an uneven floor covered with yellow or sanious pus. These sores vary in number from one to forty or fifty. They may last for months and then heal spontaneously, or may continue to spread until arrested by suitable treatment. There is no enlargement of adjacent glands, and but little inflammatory reaction in the surrounding tissues; nor is there any marked constitutional disturbance. Recovery is often followed by cicatricial contraction leading to deformity of the face.
The treatment consists in destroying the original papule by the actual cautery, acid nitrate of mercury, or pure carbolic acid. The ulcers should be scraped with the sharp spoon, and cauterised.
Chigoe.—Chigoe or jigger results from the introduction of the eggs of the sand-flea (Pulex penetrans) into the tissues. It occurs in tropical Africa, South America, and the West Indies. The impregnated female flea remains attached to the part till the eggs mature, when by their irritation they cause localised inflammation with pustules or vesicles on the surface. Children are most commonly attacked, particularly about the toe-nails and on the scrotum. The treatment consists in picking out the insect with a blunt needle, special care being taken not to break it up. The puncture is then cauterised. The application of essential oils to the feet acts as a preventive.
Poisoning by Insects.—The bites of certain insects, such as mosquitoes, midges, different varieties of flies, wasps, and spiders, may be followed by serious complications. The effects are mainly due to the injection of an irritant acid secretion, the exact nature of which has not been ascertained.