628 THE ANIMAL PARASITES OF MAN 



and spreads outwards, and when healing is complete, a depressed, 

 whitish or pinkish scar remains. 



Many treatments for Oriental sore have been devised but do not 

 seem particularly satisfactory. Castellani and Chalmers state that 

 the scabs should be removed by boracic acid fomentations, and the 

 ulcers thoroughly disinfected once or twice daily with a i per 1,000 

 solution of perchloride of mercury, after which an ordinary antiseptic 

 ointment is applied. 



The use of permanganate of potash has been advocated both by 

 French and English doctors. Both large and small sores can be 

 treated. The patient's skin around the sore is protected by a thick 

 layer of vaseline, and the surface of the ulcer powdered with potassium 

 permanganate, which is kept in position by a pad of gauze and a 

 bandage. The treatment is said to cause great pain for six to eight 

 hours, but at the most, three treatments are necessary before the sore 

 becomes a simple ulcer, well on the way to healing. The perman- 

 ganate may also be used in ointment. Excision of the ulcer when 

 small is advisable when the site of the ulcer permits of this. According 

 to Manson, reports on treatment by radium, salvarsan and carbon 

 dioxide snow are decidedly promising. Mitchell (1914) * reports 

 favourably on the use of carbon dioxide snow in the form of a pencil, 

 in India. In Brazil several workers (1914) record successful results 

 from the intravenous injection of a i per cent, solution of tartar 

 emetic in distilled water. Low (1915) has successfully treated a case by 

 direct local application of tartar emetic. Row (1912) has treated cases 

 of Oriental sore by inoculation of killed cultures of the causal organism. 



As the disease is very contagious, the slightest wound, and any 

 insect bite, should be thoroughly disinfected with 5 per cent, carbolic 

 acid or iodine. Destruction of bugs, lice, and other biting insects 

 should be enforced. As dogs may contract the disease (see p. 108), 

 it is well not to allow them in the house and not to encourage undue 

 contact with them. 



Naso-oral Leishmaniasis (Espundia) due to Leishmania tropica. 



This form of Leishmaniasis has been reported from South America 

 and recently by Christopherson 2 (1914) from the Sudan. In South 

 America it is often called Espundia, also Buba and Forestal Leish- 

 maniasis. The primary lesion is found usually on the forearms, 

 legs, chest or trunk. This ulcer is of the Oriental sore type, and 

 after some months, or even as long as two years, heals up, leaving a 

 thick scar. While the ulcer is open, or more often after it has healed, 

 lesions appear on the mucosa of the mouth and nose. The hard and 



1 Jonrn. Roy. Army Med. Corps, xxiii, pp. 440-446 (see Trap. Dis. Bul!.,\, No. 5, \\ 276). 



2 Annals Tiop. Med. and Parasitol. , viii, p. 485. 



