COURSE OF ORIENTAL SORE 87 



as to build up an immunity which is usually effective for life, 

 the general symptoms are so mild as to be usually unnoticed. 

 Slight fevers and general malaise are frequent at all times in 

 tropical countries, and it would be extremely difficult to connect 

 such non-characteristic symptoms with a sore appearing perhaps 

 months afterward. There is some evidence, however, that at 

 least in some cases fevers do occur which are attributable to the 

 parasites of oriental sore. 



The nature and course of the sores vary to some extent in 

 different localities. The sore usually begins as a small dark pimple 

 which causes very slight itching and little if any inflammation of 

 the surrounding skin. The pimple grows slowly and develops in 

 one of two ways, forming either an ulcerating or a non-ulcerating 

 sore, more popularly known as female and male sores respectively. 

 In the former type, under a flaky scab which soon falls away or is 

 scratched off, there develops a shallow ulcer exuding a foul-smell- 

 ing yellow fluid. Usually the sore covers an area about the size 

 of a dollar, the older portion often healing while the ulcer is still 

 extending in another direction. The surface of the ulcer is 

 covered by red granulations which bleed readily. In most lo- 

 calities these ulcers are not painful, but those occurring along 

 the eastern slope of the Andes in Peru and Bolivia are said to be 

 very painful. 



The non-ulcerating or male sores grow slowly and develop a 

 covering of white flaky scales over a thin red skin, below which is 

 a mass of red granulations where the parasites may be found in 

 large numbers. The non-ulcerating sores sometimes break down 

 and ulcerate, but usually grow to about the same size as do the 

 " female " sores, and then gradually shrink, finally healing as 

 do the others. 



The sores, of either kind, nearly always occur on exposed parts 

 of the body, as the face, neck, arms or legs. Occasionally they 

 occur on the lips or edges of the nose and spread to the mucous 

 membranes, but this must not be confused with the mucous 

 membrane ulcerations of American leishmaniasis. A single sore 

 is the most common condition, but secondary sores sometimes 

 develop in its vicinity, and sometimes a great many sores may 

 occur on an individual. In the Peruvian uta several sores seem 

 to be the rule, these occurring at the sites of the bites of gnats 

 and possibly other insects. 



