•202 TWO CASUS OK NON-l-l.CKHATINti "OKIENTAI, SOIU: " 



siii^m->icii iiilc might, witli udvantagu, be teiiued Leislinian nodules, as the word nodule sufliciently 

 ~?'i """ describes the growth, and practically all are agreed that //. trupica plays a part, and 

 prt)bably the chief part, in their etiology. It is true that some are apparently anxious 

 to abolish the term Li'lfUiiiunla as applied to the parasite altogether, and substitute for 

 it CrithiiltHiii or llfi-pctumnHtig, but the word is now so familiar, and in such general use 

 that it might, with advantage, be retained and applied in its modified form as above 

 indicated. Apart from what has been said there is other evidence pointing to this case 

 being one of Leishman nodules. 



1. The condition is known to occur in Kgypt. 



2. E.\posed parts of the skin are chicHy atTected, the Egyptian fellah being 

 accustomed to work stripped to tlie waist. 



3. The coagulability of the blood is increased; nuukedly so. 



Carter,' however, points out that in oriental sore more than one person of a family 

 or household is rarely if ever attacked, while, as already mentioned, our second case, about 

 to be described, appears, undoubtedly, to have derived his infection from the first, two 

 of W'hose family also suffered from the disease. Gros,-' who has published an account 

 of four cases on thu .Mgerian littoral, is of Carter's opinion. In no instance was infection 

 transmitted from his cases to those in contact with them. How close this contact is likely 

 to have been, anyone conversant with Eastern customs and usages knows. Gros concludes 

 that " le bouton d'Orient parait done pen contagieux." 



The account of our second case is therefore likely to be all the more interesting. 



Case J/.^Yani Suleiman; aged 21. Soldier in No. 4 Company, 16th Battalion, 

 Egyptian Army, an Egyptian fellah from the village of Ben Abied, in the Mudirich of 

 Minieh,HJpper Egypt. He is a sturdy son of the soil, well nourished and more intelligent 

 than his compatriot. He enlisted on the same day as did Case I., and for the last five 

 months the two men have been eating together, and sleeping side by side, while they are in 

 the same section of the same company every parade. Patient denies having ever worn the 

 clothes or boots of Case I. 



Admitted October 30, with growths, very like those in Case I., situated on his 

 left thigh, right knee and left foot. On admission, he was noticed also to have a small 

 abscess below the outer canthus of his left eye. This contained pus and was evacuated. 

 It may be said at once that no Leishmania were found in the pus. 



Family histonj. — Unimportant. Nothing of interest. 



Personal history. — Patient states that as a small child he was possessed of an evil 

 spirit for a year, but otherwise lias always been healthy. No venereal history obtainable 

 and no signs of venereal disease. 



Ilisliiri/ of pn'si'iit illiii>.iii. — The first growth on the anterior surface of tlic left thigh 

 appeared four months ago, ('.'■. one month after he came into contact with Case I. 

 Ihc comrade A second lesser growth, now absorbed into the first, appeared about the same time as 

 . ,' ^ '^ did a third growth, accessorv to the fused first and second. .\ fourth, on the inner surface 

 of the right knee, is three months old, and so is a fifth on the doi'sum of his left foot 

 about half an inch from the bases of his first and second toes. The tumours itch and 

 are painful on pressure. 



Clinical exaiiiinatiim showed the patient to be perfectly healthy, with the exception of 

 the skin lesions. These are of the same type as in Case I. When punctured they yield 



' Carter, Captain R. M., loc. cil. 



" Gros, H. (June 9, 1909), " L'ulcere a Lcisbmania (bouton d'Orient) siir Ic littoral al^tirien." Jln/I. 

 Sue. Path. Kj-dI. Parii. 



