Tropical Ulcers

Result of Tests With Penicillin

By John W. Wilkinson, of Samarai

TOWARDS the latter end of the Ameri can Forces’ stay in Milne Bay, several of the doctors became very interested in the possibilities of Penicillin for medical work among the natives, and managed to make enough penicillin available for a test to be carried out on over 50 cases of tropical ulcers. The re sults from three of the cases are given below as they are typical of the others.

The Penicillin was applied topically in strength, approx. 300 units to lee distilled water. Dressings were done at 8 a.m., and a second application of the solution to the gauze dressings was made at 4 p.m., without disturbing the dressings. Com plete recovery in each case has been dramatic, and with much less treatment and in much less time than is usual.

Ordinarily, these cases would have re quired treatment for at least two months.

General treatment in each case was;— Mist Ferri et Ammon Cit Drachms iv. tds.

Cod Liver Oil „ iv. tds.

Vitamin Bi 2 tabs „ Ascorbic Acid 2 tabs

Also 3 1.V.1. of Neoassvenobillon at bi weekly intervals were given, dosage at rate of .6 Gm. per adult.

First Case

PEIWANI, female adult, aged about 32, married, several children, general condi tion good. Village on Sariba.

Admitted 29/11/45. Tropical Ulcer about 4 in. x 21 in., left shin above ankle.

Chronic. No healing. Caused by break down of old scar of previous ulcer on same site, which was healed about one year ago. Somewhat punched out ap pearance. By 3/12/45, tissue at base of Tropical Ulcer was pink and granulating up, edge healing in rapidly. 5/12/45 — split skin graft to area, penicillin dressings on graft. 13/12 45—graft taken well.

Penicillin dressings b.d. 14/12/45 —dusted with Sulphanilamide powder; cod-liver oil and vaseline dressing. 19/12/45 —discharged.

Second Case

BENARUA, half-caste child, lived in village since birth, aged about ten years.

Village on Sagarai.

Admitted 1/12/45. Tropical Ulcer on lower third of right leg. Size 2I in. x li in., of recent origin, very dirty, fungating.

By 4/12/45, ulcer clean and fungations settled down in healthy surface. Snlit skin graft, penicillin dressings. Patient discharged 15/12/45. This is the quickest complete recovery from Tropical Ulcer noted to date at this hospital.

Third Case

TIMOTEO, male child about 9. Village on Fife Bay.

Admitted 1/12/45. Extensive Tropical Ulcer, front of right leg, size about 3 i in. x 21 in. Of long standing, had been very deeplv punched out, no doubt partly exposing some of the periosteum of the tibia at one time. On admittance Tropical Ulcer was very dirty and had a base of uneven granulation issue. Some healing had taken place, patient being admitted from a mission hospital where he had been receiving treatment for three months. By 4/12/45, clean, edges healing in fast, base still uneven. 5/12/45 —split skin graft attempted, penicillin dressing. 15/1/45 —graft taken generally, but three small areas of infection. Dressed with penicillin and cod-liver oil and vaseline.

Redressed 18/12/45. 21/12/45 nicely healed—discharged.

During the whole period, there were no toxic reactions noted in any case. Since returning to this area I have seen some of the cases which were treated and there has been no breakdown of the ulcer after six months although the natives have been carrying out normal activities m the VillSiffGS The Americans considered the penicillin was too old to use. Since then, I have seen some more of the same batch used, with good results, although it has not been kept in a refrigerator for over seven months. It may not be of much use as injections, being so old, but it has still enough power to act well on ulcers.

At the time of making the tests I was an EMA in charge of a hospital, but I am not a doctor by any means. At present, I am not doing medical work and I am making these results public in the hope that some benefit may result generally. , .. Penicillin is much safer than the Sulpha drugs, and I am sorry to see that some of the more toxic of the buipna drugs are on sale to anyone who may wish to try their hand in their use.

Considerable damage can result from their use by inexperienced hands. Also, if the correct dosage is not given, the germs acquire a tolerance to the drug.

The new Comptroller of Fiji Customs, Mr. A. R. Smith, arrived in Suva by air in August.