TWO CASES OF NON-ULCEKATING " OKIENTAL SOKE " 203 



blood only, and filins of this blood show in every instance L. tropica. Those, however, 

 are not nearly so niunerous as in Case I. The greatest number was found in the knee 

 growth. They occur both free and in the mononuclears, and present no special features. 

 A good many of them appear to be smaller than those in Case I. The tumours show 

 no tendency to ulceration, and quickly heal under a scab after being punctured. Blood 

 from the skin covering the growths shows no parasites. 

 The measurements of the growths are as follows : — 



Bland i'.i(Liitiniiti(in. — The blood coagulates very rapidly. A blood count made by 

 Major Eusor on November 2, showed 4,700,000 red blood corpuscles, and 16,000 

 leucocytes. It will be remembered that the patient at this time had a boil on his face, 

 probably the cause of the leucocytosis. After a week the leucocyte count dropped to 

 12,000, although the patient was being treated by Major Ensor' with tincture of senega, 

 according to his method in kala-azar cases. As he was anxious to test the effect of the 

 drug the case was handed over to him and has not been studied so fully by us as was 

 Case I. It is chiefly of interest in that it is an example of the transmissibility of the The question 

 disease and, apparently, of the same type of the disease. What was the agent of "f "'o^e of 



. ■ transniibsion 



transmission? Was it a bed-bug? This is perhaps the most likely insect; for bugs, 

 G. lectwlarius, are a common pest in barracks tenanted by Egyptian troops. Next, most 

 likely, is a Phlehotomus , said by Pressat,- to be blamed by the fellaheen in Egypt, and 

 regarded by Sergent and others as a possible vector. 



This and other questions we would leave to a later paper, and conclude by thanking 

 Major Ensor, S.M.O. Khartoum, for helj) in connection with the cases, and Dr. Beam 

 for the trouble he took to secure good photographs of these interesting skin lesions. 



Note. — Since this paper was written a second article by Carter' has appeared, in 

 which he draws attention to the various types of oriental sore which exist in India, 

 mentions a non-ulcerating form, apparently not identical with that we have described, 

 and like us, takes exception to the term oriental sore, though without putting forward 

 any substitute. He also refers to the possibility of there being different varieties of 

 Leishmania, an observation with which we wholly agree, and in the light of which we 

 hope to study the parasites found in the skin lesions described. 



Additional Notes 

 By the Diuector 



The above is the account of these interesting cases as it appeared in the Jounial of the 

 Royal Army Medical Corps and the Transactions of the Society of Tropical Medicine and 



' Ensor, Major Howard (December, 1909), "The Treatment of Kala-azar by the use of Senega." 

 Journal of the Royal Army Medical Corps. 



- Pressat (1905), Pahulisme et les Mousliqaes. Paris. 



■' Carter, Captain R. M. (November G, 1909), "A Note on Oriental Sore." IJriliak Malical Jountal. 



