ORIENTAL SORE IN AMERICA 209 



sores do not seem to ulcerate so markedly as they 

 do in Asia, though they may be numerous and on all 

 parts of the body. It is unknown how the disease 

 is spread. The natives consider that the bed-bug 

 and the sand-fly are probably responsible, while 

 accidental acquisition by contact was possible in the 

 case of certain soldiers who slept with infected com- 

 rades, though here there was also the possibility of 

 insect agency. 



South America also is now a home of skin 

 leishmaniasis. The disease is known in Dutch 

 Guiana as " Boschyaws," in British Guiana as 

 " Forest yaws," while in French Guiana it is called 

 " Pian-bois." Dr. Flu, who has worked in Dutch 

 Guiana, brings some evidence to show that ticks 

 carry the disease. The malady also occurs in 

 Brazil and Panama. In South America it seems to 

 affect the mucous membrane of the mouth, lips, and 

 nose, as well as the ears and skin. The disease lasts 

 a variable time, and produces emaciation and some- 

 times grave prostration. 



The appearance and structure of the ulcers seem 

 to differ considerably in Oriental Sore as observed in 

 the Eastern and in the Western Worlds. Careful con- 

 sideration of these appearances, the duration of the 

 disease, possible carrier and pathological effects, has 

 led to the opinion that several varieties of skin 

 leishmaniasis occur, and that the diseases of the skin 

 known under that name, or that of Oriental Sore, 

 will need to be re-classified. Until the full life- 

 history of the parasite has been worked out in each 

 case, attempts at natural classification can only fail, 

 14 



