Two Casks of Non-Ulceuatino "Ouiextal Sore," better termed 



Leishman Nodules 



BY 



The Director 



WITH Clinical Notes by 



Captain D. 8. U. Thomson, M.B., B.Ch., B.A.O., D.P.H., R.A.M.C. 



Attaclied Egyptian Army 



Introduction 



There came recently under the care of one of us (D.B.T.), an Egyptian soldier 

 (Case I.) with a peculiar skin lesion, the character of which is well shown in the 

 accompanying photographs taken by Dr. Beam. The patient was sent to the Wellcome 

 Tropical Kesearch Laboratories, where it was suggested that it would be well to examine 

 the contents of the skin lesions and also to make a histological examination of the growths. 

 This was done by one of us (A.B.) with the result that large numbers of a species of 

 Leishman-Donovan body, presumably L. tntpica, were found, but while some sections of the 

 growths bore a close resemblance in their pathological histology to true oriental sore, others 

 presented peculiar features. Indeed, both clinically and histologically, the condition was 

 at first suggestive of that rare skin disorder which bears many different names, but is 

 perhaps best described as benign multiple cystic epithelioma or epithelial cystadenoma 

 of the skin. The history showed that we wei'e dealing with a disease of considerable 

 interest, an interest not lessened by the discovery of a second very similar case, which, in 

 all probability, had become infected from the first. 



It is proposed in the present paper to discuss the condition generally, to give the 

 clinical histories of the two cases, and to deal with the microscopic findings, while mention 

 will also be made of certain efforts to cultivate the parasite, to carry out animal 

 inoculation and as regards the question of prophylaxis and treatment. 



Cose I. — Ahmed Hussein (Fig. 40), soldier in No. 4 Company, 16th Battalion, Egyptian 

 Aruiy, aged 20, an Egyptian fellah from the village of Nezli Bedeni in the Mudirieh of 

 Minieh, Upper Egypt. He is a stoutly built man, not very intelligent, in good condition, 

 but not of such fine physique as is usually seen amongst the Egyptian soldiery. He 

 has had five months' service in the Egyptian Army, the last four months of which 

 have been spent in the Sudan. 



Admitted to the Military Hospital, Khartoum, on October 9, with soft, pink, keloid-like, 

 raised growths on the face, neck, shoulders, arms, back and inner surface of the thigh. 



Famihj lustonj. — Father, aged about 70, developed dinihir i/rou-thb- iiix years ayu, 

 and at the present time they are more numerous and much larger on his body than on that 

 of his son. Since the growths appeared he has become a lunatic and has lost his hearing. 

 The tumours are said to be in some instances many inches in diameter, and have never 

 shoived aiiij signs of ulceration or breakimj doivii. 



Mother dead, cause unknown. 



