424 FAMILY: TRYPANOSOMID.E 



are confined to the skin, they appear to be of a more chronic character 

 than those of the Old World, while in about 10 per cent, of cases the 

 mucosae are involved. This latter condition produces in the mouth, 

 pharynx, and nose extensive ulcerations and necroses, which may last 

 for years, and reduce the victim to a condition of profound cachexia. In 

 the Old World type, occasionally, ulceration may extend from the skin to 

 the inner surface of the lips or nose, as recorded by Cardamatis and 

 Melissidis (1911), in Greece by Pulvirenti (1913), and La Cava (1912 and 

 1914) in Italy, and by Christopherson (1914) in the Sudan. In these cases 

 there is not the extensive involvement of the post-pharyngeal region so 

 characteristic of the disease in South America. Castellani (1913), however, 

 claims to have discovered leishmania in the pharyngeal ulcerations of a case 

 in Ceylon. There had been no previous skin lesion, and, as Laveran (1917) 

 remarks, if this was a case of infection with L. tropica, a fact which was not 

 demonstrated, the case is quite abnormal and of an exceedingly rare type. 



DISTRIBUTION. — The distribution of oriental sore is a very wide one. 

 It occurs in Spain, Italy, and Greece, and more recently a case has been 

 described from France by Ravaut (1920). It is fairly common in North 

 Africa, and has been found in various localities along the northern coast 

 area, especially at Biskra. It is found in Egypt and the Sudan, and also 

 in the French Congo, in the district of Lake Chad, and on the Niger. Asia 

 Minor, Arabia, Mesopotamia, Persia, and the southern parts of Russia 

 are endemic centres. In India it is common along the north-west frontier 

 districts, and even farther south, as at Cambay near Bombay. It does 

 not, however, extend to the kala azar areas in the east. In America it 

 occurs chiefly in Brazil and Peru, but also frequently in Guiana, Paraguay, 

 Panama, Yucatan. Cases have also been recorded from the Argentine, 

 Uruguay, Bolivia, Equador, Colombia, and Venezuela. The disease in 

 the New World is known under various names, such as espundia, uta, buba, 

 pian-bois, forest yaws, bosch yaws, and has been known for many years, 

 though it was not till 1909 that Lindenberg, Carini, and Paranhos demon- 

 strated leishmania in the ulcer of Bauru in Brazil. Splendore (1911) and 

 Carini (1911) were the first to show that the disease of the naso-pharyngeal 

 region was due to infection with leishmania. 



It is thus quite clear that, though in most cases the disease in South 

 America is limited to the skin, and in this respect resembles the disease of 

 the Old World, in a certain percentage of the cases secondary lesions appear 

 in the naso-pharyngeal mucosa and lead to a very chronic type of ulcera- 

 tion. Furthermore, the purely cutaneous type appears to be more severe 

 and of longer duration than the oriental sore of the East, which rarely 

 lasts for more than a year or eighteen months. It is possible, therefore, 

 that the parasites causing the two diseases are not identical. Vianna 



