DELHI BOILS. This is by no means a novel subject, in fact it is one which has occupied the pages of various medical periodicals in this Presidency since 1813. In November 18G9 wo published a paper on The Delhi Ulcers" by Dr, J. Fleming (Staff Assistant Surgeon), in which he very justly remarks that these boils "remain a paradox" at the present time, and that notwithstanding all the suggestions that have been pointed out for their removal, they are yet very prevalent, and affect more than 15 per cent, of the troops stationed at Delhi. Staff Surgeon Major Alexander Smith gives a remarkably good account of the symptoms of the Delhi ulcer, (page 322 of the Army Medical Department Report for 18(58, published in 1370) ; he describes two principal varieties of these ulcers. In "
the
one
he writes :?" the earliest indication of the formation of
usually discovered in the form of a small, slightly painless papule, which shows but slight inflammatory redness. After the lapse of several weeks, the papule, in one form of boil, slowly developes itself into a small, flattened, indolent abscess, 'which, either when left to burst of iis own accord, or when opened by incision, is found to have been a
Delhi boil is
elevated,
almost
filled with pus mixed with blood of "
Of this last, also, there is
after the have been
pit, not
dark
generally
venous a
original discharged, take
a
colour.
pretty copious
contents have been evacuated.
which fob
readily
a
flow
When these
there remains
an apparently excavated enlarge by ulceration, does healing action, and, when it does so, fills
time continues to
on a
up with extreme slowness. " Coincident with the later area
changes in the original boil, the being gradually extended by a zone slight tumefaction. This, on close inspection,
of diseased skin is
of redness with
is found to be made up the
original
one.
of
a
fresh set of
These fresh
points
papules
similar to
of disease are,
as
a
50
TIIE INDIAN MEDICAL GAZETTE.
general rule, arranged circumferentially to tlie original one, with which, as with each other, they appear to be continuous, owing to the blending of their marginal redness where they touch. "
A process of slow suppuration, and of changes similar to those which took place in the original point of disease, happens to
these "
secondary
ones
also.
changes
general boil is being extended by
differing only
zones,
ing
on, the
still further addition of
set becomes less marked than their
it fades away into the
ally
going
from the first in the fact that each succeed-
power of further advance would "
a
are
predecessors,
to
seem
surrounding healthy
until the
fail the disease, and skin.
process, which commences in the centre, gradufollows the spread-of the diseased action outwards (both
The
healing going
processes
on
at the
same
time),
until
eventually,
after
perhaps many months cf tedious progress, the ulcerated surface heals entirely, leaving only a very shallow but deeply-colored cicatrix. "
In
a
second well-remarked
of the disease is still
more
variety
of Delhi
indolent in
boil, the course character, and slow in
progress, than that which has just been described. The formation of pus is less decided, and the tendency is, for what does
form,
to
get
crusted
over
ulcer underneath.
and dried into
a
scab which conceals
Like the first
variety, this also extends, original boil, by rings of fresh points of disease, these becoming less active in character, and more slightly marked in degree, as the distance from the centre increases, until at last, as they become shaded into the sound skin, the whole puts on very much the appearance of an ordinary ringworm." With reference to the etiology of these Delhi sores, Dr. A. Smith observes that they attack those parts of the body which are least carefully dried after washing, and to which, from their position, the water gravitates in ordinary ablution, as for example the ulnar portion of the back of the forearm, a little above the wrist, the points of the elbow, and so on. Dr. Smith further noticed that scarcely a single dog belonging to the military, which may have been for any length of time in Delhi, escaped contracting the disease on the tip of the nose." With an
at the circumference of the
"
facts such
as
these before him he argues that it
that Delhi ulcers
seems
very
something contained in the water used by the troops and dogs in the locality, as in the human and canine species parts protected from water escape the disease, whereas those constantly in contact with water are affected. This line of argument is rendered the more forcible, because it is impossible to explain the circumstances of the " condisease by attributing it, as has usually been the case, to a to mere other in conventional stitutional defects," or, words, phrase, employed too often by medical men as a cloak for ignorance, and which, Dr. Smith remarks, had in this instance been most unsatisfactory to man and beast, in theory and practice. The question naturally arose, as to what the waters of Delhi and such like places could possibly contain, which was capable of inducing the Delhi sores. And here we come to the weak point in the case?the point, however, of the greatest interest, and the key-stone of tlie whole structure. We are sorry to find those mysterious little
probable
depend
upon
1871.
life, our bug-bear apparently at present?as " constitutional defects" formerly were?the much abused " animalcules or their ova," fixed upon as the germs from which the Delhi
bits of
ulcers spring. The idea once started, the microscope is immediately brought into play, and an examination made of the Delhi waters. As these doubtless contain much organic matter m
At the same time that these
[Matich 1,
a
state
consists of
of
decomposition,
organic
and the surface of
matter in
a
somewhat
a
Delhi sore
similar, although
concentrated state, it is hardly improbable that at times, the water on the one hand, and matter from a sore on the other, should exhibit
analogous forms of animalcules, but it hardly lowly organic bits of life, found in the debris of the ulcer, have originated from the water of the locality* and still less, that the animalcules in the fluid have been the
follows that these
cause
of the sores.
Ibis field of
enquiry is nevertheless a most interesting one. Fleming have led the way, and we earnestly hope that during the hot season, the period above all others adapted for microscopical work in India, some of the medical Drs. A. Smith and
officers
which
residing are
places, the inhabitants of ulcers, will thoroughly investigate should, indeed, be pleased to have the
at Delhi, and other
affected with these
the matter at issue ; we honor of publishing their results in the pages of this journal.
the
one
he writes :?" the earliest indication of the formation of
usually discovered in the form of a small, slightly painless papule, which shows but slight inflammatory redness. After the lapse of several weeks, the papule, in one form of boil, slowly developes itself into a small, flattened, indolent abscess, 'which, either when left to burst of iis own accord, or when opened by incision, is found to have been a
Delhi boil is
elevated,
almost
filled with pus mixed with blood of "
Of this last, also, there is
after the have been
pit, not
dark
generally
venous a
original discharged, take
a
colour.
pretty copious
contents have been evacuated.
which fob
readily
a
flow
When these
there remains
an apparently excavated enlarge by ulceration, does healing action, and, when it does so, fills
time continues to
on a
up with extreme slowness. " Coincident with the later area
changes in the original boil, the being gradually extended by a zone slight tumefaction. This, on close inspection,
of diseased skin is
of redness with
is found to be made up the
original
one.
of
a
fresh set of
These fresh
points
papules
similar to
of disease are,
as
a
50
TIIE INDIAN MEDICAL GAZETTE.
general rule, arranged circumferentially to tlie original one, with which, as with each other, they appear to be continuous, owing to the blending of their marginal redness where they touch. "
A process of slow suppuration, and of changes similar to those which took place in the original point of disease, happens to
these "
secondary
ones
also.
changes
general boil is being extended by
differing only
zones,
ing
on, the
still further addition of
set becomes less marked than their
it fades away into the
ally
going
from the first in the fact that each succeed-
power of further advance would "
a
are
predecessors,
to
seem
surrounding healthy
until the
fail the disease, and skin.
process, which commences in the centre, gradufollows the spread-of the diseased action outwards (both
The
healing going
processes
on
at the
same
time),
until
eventually,
after
perhaps many months cf tedious progress, the ulcerated surface heals entirely, leaving only a very shallow but deeply-colored cicatrix. "
In
a
second well-remarked
of the disease is still
more
variety
of Delhi
indolent in
boil, the course character, and slow in
progress, than that which has just been described. The formation of pus is less decided, and the tendency is, for what does
form,
to
get
crusted
over
ulcer underneath.
and dried into
a
scab which conceals
Like the first
variety, this also extends, original boil, by rings of fresh points of disease, these becoming less active in character, and more slightly marked in degree, as the distance from the centre increases, until at last, as they become shaded into the sound skin, the whole puts on very much the appearance of an ordinary ringworm." With reference to the etiology of these Delhi sores, Dr. A. Smith observes that they attack those parts of the body which are least carefully dried after washing, and to which, from their position, the water gravitates in ordinary ablution, as for example the ulnar portion of the back of the forearm, a little above the wrist, the points of the elbow, and so on. Dr. Smith further noticed that scarcely a single dog belonging to the military, which may have been for any length of time in Delhi, escaped contracting the disease on the tip of the nose." With an
at the circumference of the
"
facts such
as
these before him he argues that it
that Delhi ulcers
seems
very
something contained in the water used by the troops and dogs in the locality, as in the human and canine species parts protected from water escape the disease, whereas those constantly in contact with water are affected. This line of argument is rendered the more forcible, because it is impossible to explain the circumstances of the " condisease by attributing it, as has usually been the case, to a to mere other in conventional stitutional defects," or, words, phrase, employed too often by medical men as a cloak for ignorance, and which, Dr. Smith remarks, had in this instance been most unsatisfactory to man and beast, in theory and practice. The question naturally arose, as to what the waters of Delhi and such like places could possibly contain, which was capable of inducing the Delhi sores. And here we come to the weak point in the case?the point, however, of the greatest interest, and the key-stone of tlie whole structure. We are sorry to find those mysterious little
probable
depend
upon
1871.
life, our bug-bear apparently at present?as " constitutional defects" formerly were?the much abused " animalcules or their ova," fixed upon as the germs from which the Delhi
bits of
ulcers spring. The idea once started, the microscope is immediately brought into play, and an examination made of the Delhi waters. As these doubtless contain much organic matter m
At the same time that these
[Matich 1,
a
state
consists of
of
decomposition,
organic
and the surface of
matter in
a
somewhat
a
Delhi sore
similar, although
concentrated state, it is hardly improbable that at times, the water on the one hand, and matter from a sore on the other, should exhibit
analogous forms of animalcules, but it hardly lowly organic bits of life, found in the debris of the ulcer, have originated from the water of the locality* and still less, that the animalcules in the fluid have been the
follows that these
cause
of the sores.
Ibis field of
enquiry is nevertheless a most interesting one. Fleming have led the way, and we earnestly hope that during the hot season, the period above all others adapted for microscopical work in India, some of the medical Drs. A. Smith and
officers
which
residing are
places, the inhabitants of ulcers, will thoroughly investigate should, indeed, be pleased to have the
at Delhi, and other
affected with these
the matter at issue ; we honor of publishing their results in the pages of this journal.
