90 LEISHMAN BODIES AND LEISHMANIASIS 



times nearby lymph glands also become infected. Such general 

 symptoms as evening fever, pains in the joints, headache, etc., 

 sometimes accompany the ulceration, probably due to the ab- 

 sorption of toxins. 



As remarked before, the exudations from the sores are extremely 

 infectious for either the same individual or another one. Con- 

 sequently it is not infrequent to find on a single individual a 

 great many sores, up to 50 or more, in all stages of development, 

 though more often there are only a few. In one case recorded 

 from Brazil there were 35 active sores and 29 extinct ones, and 

 these were arranged in a more or less symmetrical manner, sug- 

 gesting the influence of the nervous system on their location. 

 The sores become secondarily infected with bacteria and spiro- 

 chsetes and are sometimes attacked by screw-worms and other 

 fly maggots. The rarity of Leishman bodies in the late stages of 

 the sores suggests that the secondary infections may then play 

 an important role, though the prompt cure which follows treat- 

 ment destructive to the protozoans shows that the latter still play 

 a leading part. 



Mucous Membrane Ulceration. A far more vicious mani- 

 festation of the disease and one which follows the cutaneous sores 

 is the ulceration of the mucous membranes of the nose and mouth 

 (Fig. 16). It may be several months or over a year after the 

 skin sores develop and often after they have healed that the 

 mucous ulcerations appear. In rare cases ulcers have been 

 known to occur in the vagina also. Ordinarily the infection 

 commences as a tiny itching hardness or swelling of the mucous 

 membrane, usually in the nose, the infected membrane becoming 

 inflamed, and marked either with small granular sores or with 

 blister-like swellings. The lymph glands in the infected regions 

 become swollen and turgid. A granular ulceration begins in a 

 short time, invading all the mucous membranes of the nose and 

 spreading, by means of infective fluid which flows down over the 

 upper lip, into the mouth cavity, attacking the membranes of 

 the hard and soft palate. Its advance is obstinate and slow, and 

 gives rise to serious complications. The nostrils become too 

 clogged to admit the passage of sufficient air and the patient 

 has to keep his mouth constantly open to breathe. His repul- 

 sive appearance and fetid breath help to make his life miserable. 

 Affections of the organs of smell and hearing, and even sight, 



