204 TWO CASUS 01'' NON-ULCKRATING " OUIENTAfi SOUK " 



Hi/f/ii'iir. Before it was conn)leted, Captain Tlionison had unfortunately to leave for the 

 Blue Nile Province. I was practically alone in tiie laboratories at the time and, as has 

 occurred only too frequently in the past, found myself unable to cope properly with all the 

 researci) and routine work. This is probably the reason why my attempts to cultivate the 

 parasite failed, though it is true I wasted a great deal of time in preparing and using the 

 somewhat elaborate medium and following the tcchiii(iue devised by Carter.' At that time 

 I had not seen Row's- work, or NicoUe's-' paper in wliicli the agar-sea-salt medium is 

 described. I was only able to examine the cases at intervals, and it so liappcned that, as a 

 result of painting with tincture of iodine, and perhaps also on account of the puncturings to 

 which they were subjected, the nodules gradually shrivelled up and disappeared, the 

 parasites wholly vanishing from their contents. Hence, by the time I had a little more 

 leisure my material was lost and there has been no opportunity of obtaining more, and 

 although Captain Archibald records a case of cutaneous Leishmaniosis, it was not of the 

 nodular type but answered to the descriptions of skin lesions given by Day and Ferguson,'' 

 being more allied to tiie warty forms mentioned by Ferguson and Richards'' as occurring 

 in Egypt. 



It is perhaps scarcely worth while giving the progress of the cases in detail. It was 

 ircainicnt noted from time to time, and the effectiveness of the iodine treatment has been mentioned. 

 This was different from the experience of Ferguson and Richards who found that ionisation 

 of their " flat forms," wliich tliey think are the same as those here described, only caused a 

 temporary and very slow iinijrovenient. Possibly, however, a good deal depends on the size 

 of the lesion. They recommend excision followed by skin-grafting, and certainly this seems 

 the best method of treatment as under the iodine regime our two cases were not well and fit 

 for duty until the middle of January, 1910. Moreover, somewhat unsightly scars were left 

 where the nodules had been. The senega treatment did not seem to have any effect. 



Anitiial inoculatums. — I was only able to carry out one experiment, a skin inoculation 

 by scarification in the flank of a guinea-pig. The result was negative, but thanks to the 

 recent work of Nicolle and Manceaux'' we now know tliat, under certain conditions, 

 oriental sore can be communicated to tliu smaller monkeys and to the dog wlu'ii culture 

 forms are employed. 



The goat, cat, sheep, white rat, ass and horse are not susceptible. The guinea-pig 



is only mentioned indirectly, but it would appear that it can be infected if the inoculation 



is made in the thickness or the neighbourhood of the skin. Failure, therefore, in the case 



lixpcrinicnial nientioned, was probably due to the fact that the material employed was taken direct 



^™'''< from the lesion and not from cultures of the parasite. In any case, however, no information 



of any value can be obtained from a solitary negative experiment. 



Mention has been made of the failure of attempts at cultivation on Carter's medium. 

 These also failed in citrate solution, and on ordinary blood agar. 



' Carter, Captain H. M. '.Soptemlicr 11, 1909), "Oriental Sore of Northern India. A Protozoal Infection." 

 lirilinh Medieiil Joiiriinl. 



' Row, R. (1909), " Developineut iit Flagellated Organisms from the Piiriisitc of 'Oriental Sore.'" 

 Tratmaetions Bonibni/ Medical ('oinjrc^i. 



" Nicolle, C. (April, 1908), " Re(^herehes sur le Kala-azar, Isolcmcut ct Culture des Corps de 

 Lcisbman." jtrch. de I'liist. PaM. de Tunis. 



* Day, H. B., and Ferguson, A. R. (November 1, 1909), " An account of a form of Splenomegaly with 

 Hepatic Cirrhosis, Endemic in Egypt." Annals iif Tropical Medicine and ParasiloliKjij. Liverpool. 



" Ferguson, A. R., and Richards, Owen (.Tuly 2.o, 1910), " Parasitic Granuloma." Annnh nf Tropical 

 Medicine and I'arasilulo;/!/. liiverpool. 



" Nicolle, C, and Sfanceau.x, L. (Septeml)cr 2.5, 1910), " Rechcrchcs sur Ic bouton d'Orient — Cultures, 

 Reproduction experimentale, Immunisation." Ann. de I'lnM. P<isl. Paris. 



