Tropical Ulcer 531 



Nicolle found an organism that was not distinguishable either by 

 microscopic examination or by cultivation from Leishmania dono- 

 vani, but, finding that it was infectious for dogs, he came to the con- 

 clusion that it was a separate species, and called it Leishmania 

 infantum. He also found that the dogs in Tunis frequently suf- 

 fered from spontaneous infection from this parasite, and it is possible 

 that it is from the dogs that the children become infected. 



Further experiments with this parasite by Nicolle and Comte 

 have shown that in the form in which it occurs in the human spleen 

 it is capable of infecting monkeys, and Novy has succeeded in 

 cultivating the organism and infecting dogs with artificial cul- 

 tures containing its flagellate forms. 



It is now thought by many that infantile kala-azar and Indian 

 kala-azar are identical diseases, caused by identical parasites. In 

 considering the probable source of the disease Stitt* says: "It has 

 been suggested that the Mediterranean basin may have been the 

 original focus of visceral kala-azar and that it spread thence to India 

 by way of Greece and the Russian Caucasus, cases having been re- 

 ported from districts which would join the two foci. Just as chil- 

 dren bear the brunt of malaria in old malarial districts and adults 

 suffer in places in which the disease has been more recently im- 

 ported, so by analogy we may consider the disease as of more 

 recent introduction in India .... In the Mediterranean basin 

 there is a natural canine Leishmaniasis and some think the human 

 form may be contracted from the dog through the medium of the 



TROPICAL ULCER 



LEISHMANIA FURUNCULOSA (FIRTH) 



In India, northern Africa, southern Russia, parts of China, 

 the West Indies, South America, and, indeed, most tropical countries, 

 a peculiar intractable chronic ulceration is occasionally observed, 

 and is variously known as Tropical ulcer, Oriental sore, Biscra boil, 

 Biscra button, Aleppo boil, Delhi boil, Bagdad boil, Jericho boil, 

 and Buton d'Orient. It has long been known as a specific ulcerat- 

 ing granuloma. The lesions, which begin as red spots, develop into 

 papules which become covered with a scaly crust which separates, 

 leaving an ulcer upon which a new crust develops. The lesion 

 spreads and is much larger when the crust again separates. A 

 purulent discharge is given off in moderate quantities and the 

 ulcer becomes deep and perpendicularly excavated. It lasts for 

 months sometimes a year or more and gradually cicatrizes, 

 forming a contracting scar that is quite disfiguring when upon the 

 face. The lesions may be single, though they are commonly mul- 



* Diagnosis and Treatment of Tropical Diseases, 1914, p. 75. 



