BRIEF NOTES ON THE SO-CALLED
'
PANJDEH
SOKE.'* By Surgeon C. W. With the
OWEN,
Afghan Boundary
Commission.
As a certain amount of discussion lias lately taken place in the Medical Press regarding the character and treatment of the above disease, I venture to offer a few remarks from brief notes made on the subject during the stay of the Afghan Boundary Commission on the Afgban-Russian frontier, which may, perhaps, be of interest at the present moment. The description given of the disease by Dr. Suski coincides with what I have seen, and I give the following extracts from my note-book:?
jDescription of
the
Panjdeh
Sore.
In the earliest stage the disease appears small pimple, which hardens as it gradually enlarges, unattended at first with much dis1.
as a
comfort
;
suppuration follows, leaving
some-
* We are indebted to the Surgeon-General with the Government of India for these interesting notes.?Ed., I. M. O.
THE PANJDEH SORE.
Oct., 1886.] times sore
a
but more often a nasty rugged the whole substance of the skin.
circular,
involving
The sore resulting enlarges slowly, presenting often the appearance of specific ulceration, with a free secretion of pus and with No glandular thickened hardened margins. but. in the neighexists, swelling enlargement bourhood of the sore is occasionally met with. In this stage pain is at times severe, and patient may have as many as a hundred of these sores, usually as many as six to ten. The healing is by grauulation, which even3. tually leaves a well-marked depressed cicatrix, which, if on the face, greatly disfigures. The statement made by Dr. Suski is t( that close to the primary sore a second develops, running the same course, this being succeeded by others which amalgamate and form com" This state of matters is not, pound sores. as far as my experience goes, usual by any meaus, and depends a great deal on the treat2.
297
Cause?(1) Irritation of skin by sand and dirt, and want of cleanliness. (2) A scorbutic tendency. (3) Intense heat with its well known sequel?. In iny own mind I feel convinced that, in a large proportion of cases, scurvy has been at the bottom of the mischief, and I now always
look out for scorbutic symptoms whenever a himself for treatment suffering from the disease. Whether signs of scurvy were present or not?and usually they were?I made a point of giving the following mixture :
patient presents
Acid Tartaric
Sp. Ammoa. Aquae
...
Aromat. ...
grs.
xv
...
...
...
...
mm. xv
...
...
ozs.
ii
To be taken after effervescence has subsided. I notice that the disease is said by some to be due to a micro-organism present in immense numbers in the water of the Murjjhab and to O innumerable bacteria in the air of the valley. ment adopted. I regret I had not the means or opportunity of Dr. Pierson states that, when these sores settling this point; but at all evenis before we have existed a long time, they leave a permaaccept this statement, it would be well to know This is hardly borne nent dull brown skin. if the appearance of bacteria in the air and out by what I have seen; on the contrary, micro-organisms in the water in such numbers the majority of them leave a firm white cicatrix, coincides with the outbreak of the disease. I which cau be easily distinguished from the should myself doubt it, for the following reason, that boils are exceedingly common in the Herat coppery colour of cicatrices due to specific ulceration. province among the nomad population during Another point worthy of notice is that the the summer season, aud generally the nomads cicatrix is often very irregular in outline. pass this season of the year in the mountains at an The history of the disease is most important. altitude of from 4,000 to 7,000 feet above seaThese sores only appear during the hot season, level. Again, although the Mission remained and in many cases?adopt auy form of treatment for many monthsin the Murghab Valley, only two suitable?-the sore will not commence to heal of our followers were attacked by this disease. before the cold season sets in. On the other hand,we were not in the Murghab If the sore is left alone, it heals by itself in Valley during the intense heat of summer. about 12 months' time; so well is this known in In remarking on the outbreak of this disease Persia, where these sores are as common as among the Russian troops at Panjileh, wlio measles in Europe, that the name given to the were affected to the extent of some 80?90%, disease is " Dhana-i-Salir," or the sore lasting a it would be well to consider the position of the year. Russian camp which was situated on the bank Treatment. of the river just below the junction of the My experience hardly coincides with that of Kushk and the Murghab rivers. There is Dr. Pierson. In the earliest stages I have found very little water iu the Kushk river during the nothing so useful as the application of solution summer, and in many places it dries up; what argenti nitratis (20 grs. to one ounce), which water there is is so brackish as to be undriukable. has in mauy cases prevented the boil reaching Throughout the East, boils aud sores are the stage of ulceration. When ulceration sets We have the Delhi sore, common ailments. in, I use the same solution of nitrate of silver or Scinde sore, Aden boil, Persian sore, Baghdad sometimes the crayon of silver and potash combut as ulcer, and in Bokhara "the sart disease bined ; and, if not successful with this, a lotion far as I know, there*is little at present known of sulphate of iron (4 grs. to the ounce) on which would enable us to distinguish one from lint and covered with guttapercha tissue. In the other. The Russians have told me of a one case I used the actual cautery, and the similar kind of sore which is common in the result was decidedly encouraging. Poulticing It would, I think, simplify matters Caucasus. should never be employed, as it only causes the if in future the name "Oriental sore" was ulcer to spread. If the sore is situated on the adhered to for all the above, including the face or neck, the pain is easily relieved by a Panjileh sore, until such time as the microscope over the cocaine of solution painted has revealed to us the differences, if auy, which part 4?/ affected. exist between them. #
'
PANJDEH
SOKE.'* By Surgeon C. W. With the
OWEN,
Afghan Boundary
Commission.
As a certain amount of discussion lias lately taken place in the Medical Press regarding the character and treatment of the above disease, I venture to offer a few remarks from brief notes made on the subject during the stay of the Afghan Boundary Commission on the Afgban-Russian frontier, which may, perhaps, be of interest at the present moment. The description given of the disease by Dr. Suski coincides with what I have seen, and I give the following extracts from my note-book:?
jDescription of
the
Panjdeh
Sore.
In the earliest stage the disease appears small pimple, which hardens as it gradually enlarges, unattended at first with much dis1.
as a
comfort
;
suppuration follows, leaving
some-
* We are indebted to the Surgeon-General with the Government of India for these interesting notes.?Ed., I. M. O.
THE PANJDEH SORE.
Oct., 1886.] times sore
a
but more often a nasty rugged the whole substance of the skin.
circular,
involving
The sore resulting enlarges slowly, presenting often the appearance of specific ulceration, with a free secretion of pus and with No glandular thickened hardened margins. but. in the neighexists, swelling enlargement bourhood of the sore is occasionally met with. In this stage pain is at times severe, and patient may have as many as a hundred of these sores, usually as many as six to ten. The healing is by grauulation, which even3. tually leaves a well-marked depressed cicatrix, which, if on the face, greatly disfigures. The statement made by Dr. Suski is t( that close to the primary sore a second develops, running the same course, this being succeeded by others which amalgamate and form com" This state of matters is not, pound sores. as far as my experience goes, usual by any meaus, and depends a great deal on the treat2.
297
Cause?(1) Irritation of skin by sand and dirt, and want of cleanliness. (2) A scorbutic tendency. (3) Intense heat with its well known sequel?. In iny own mind I feel convinced that, in a large proportion of cases, scurvy has been at the bottom of the mischief, and I now always
look out for scorbutic symptoms whenever a himself for treatment suffering from the disease. Whether signs of scurvy were present or not?and usually they were?I made a point of giving the following mixture :
patient presents
Acid Tartaric
Sp. Ammoa. Aquae
...
Aromat. ...
grs.
xv
...
...
...
...
mm. xv
...
...
ozs.
ii
To be taken after effervescence has subsided. I notice that the disease is said by some to be due to a micro-organism present in immense numbers in the water of the Murjjhab and to O innumerable bacteria in the air of the valley. ment adopted. I regret I had not the means or opportunity of Dr. Pierson states that, when these sores settling this point; but at all evenis before we have existed a long time, they leave a permaaccept this statement, it would be well to know This is hardly borne nent dull brown skin. if the appearance of bacteria in the air and out by what I have seen; on the contrary, micro-organisms in the water in such numbers the majority of them leave a firm white cicatrix, coincides with the outbreak of the disease. I which cau be easily distinguished from the should myself doubt it, for the following reason, that boils are exceedingly common in the Herat coppery colour of cicatrices due to specific ulceration. province among the nomad population during Another point worthy of notice is that the the summer season, aud generally the nomads cicatrix is often very irregular in outline. pass this season of the year in the mountains at an The history of the disease is most important. altitude of from 4,000 to 7,000 feet above seaThese sores only appear during the hot season, level. Again, although the Mission remained and in many cases?adopt auy form of treatment for many monthsin the Murghab Valley, only two suitable?-the sore will not commence to heal of our followers were attacked by this disease. before the cold season sets in. On the other hand,we were not in the Murghab If the sore is left alone, it heals by itself in Valley during the intense heat of summer. about 12 months' time; so well is this known in In remarking on the outbreak of this disease Persia, where these sores are as common as among the Russian troops at Panjileh, wlio measles in Europe, that the name given to the were affected to the extent of some 80?90%, disease is " Dhana-i-Salir," or the sore lasting a it would be well to consider the position of the year. Russian camp which was situated on the bank Treatment. of the river just below the junction of the My experience hardly coincides with that of Kushk and the Murghab rivers. There is Dr. Pierson. In the earliest stages I have found very little water iu the Kushk river during the nothing so useful as the application of solution summer, and in many places it dries up; what argenti nitratis (20 grs. to one ounce), which water there is is so brackish as to be undriukable. has in mauy cases prevented the boil reaching Throughout the East, boils aud sores are the stage of ulceration. When ulceration sets We have the Delhi sore, common ailments. in, I use the same solution of nitrate of silver or Scinde sore, Aden boil, Persian sore, Baghdad sometimes the crayon of silver and potash combut as ulcer, and in Bokhara "the sart disease bined ; and, if not successful with this, a lotion far as I know, there*is little at present known of sulphate of iron (4 grs. to the ounce) on which would enable us to distinguish one from lint and covered with guttapercha tissue. In the other. The Russians have told me of a one case I used the actual cautery, and the similar kind of sore which is common in the result was decidedly encouraging. Poulticing It would, I think, simplify matters Caucasus. should never be employed, as it only causes the if in future the name "Oriental sore" was ulcer to spread. If the sore is situated on the adhered to for all the above, including the face or neck, the pain is easily relieved by a Panjileh sore, until such time as the microscope over the cocaine of solution painted has revealed to us the differences, if auy, which part 4?/ affected. exist between them. #
