ORIENTAL SORE 177 



exposed, which slowly spreads. The surface of the ulcer 

 is studded with flabby red granulations, which bleed 

 readily on pressure; its base is freely movable over the 

 subjacent tissues, and its edges are raised, irregular and 

 slightly indurated. There is always a considerable 

 amount of thin, serous or purulent discharge which 

 coagulates, forming dirty yellow crusts. The degree of 

 pain varies ; often there is little or none, but sometimes, 

 especially if irritated, or if the discharge be pent up by 

 thick scabs, the ulcer is very pajnful and the edges acutely 

 tender. 



The ulcer slowly spreads in an irregular manner for 

 some time, often for several months, and, either of itself 

 or by coalescing with similar ulcers forms a large open 

 sore an inch or two in diameter. After a time the ulcer 

 ceases to spread and slowly heals, the healing process 

 being often interrupted by the retention of the discharge 

 beneath the crusts. Depressed, pitted, and pigmented 

 but superficial scars are left which may be mistaken for 

 those of syphilis. These ulcers are most common on 

 exposed parts of the body, especially on the face, neck, 

 wrists, and on the back of the hands and dorsum of the 

 feet. They may be single, but are more commonly 

 multiple, and are irregularly distributed. There is usually 

 no enlargement of the lymphatic glands. As a rule, 

 there is no constitutional disturbance, but if numerous 

 and severe the ulcers lead to gradual impairment of the 

 health. 



The South American form (Plate III, fig. 50) is some- 

 times known as " Forest Yaws." It has no connection 

 with yaws, Frambcesia tropica (figs. 57 and 58). 



The Sudan type (Plates IV and V, figs. 51 and 52) is one 

 of the non-ulcerating forms. The growths commence as 

 small, pink, circular points raised above the skin, which 

 gradually increase in size, and round them other similar 

 papules form. These coalesce with the primary tumour, 

 and an irregular mass is formed, pink in colour and with 

 a smooth shining surface. They are soft to the feel and 



