178 TROPICAL MEDICINE AND HYGIENE 



freely movable over the deeper tissues. They do not 

 break down, ulcerate or caseate, but may last for years. 

 A somewhat similar non-ulcerating form occurs in Egypt. 

 There are no constitutional symptoms. 



Pathological Anatomy. Oriental sore is essentially an 

 infective granuloma. The proper elements of the skin 

 and its accessories, the hair and sebaceous follicles, and 

 the sweat glands, are invaded and destroyed by granulation 

 tissue, which extends deeply into the corium and necroses 

 superficially, thus producing an ulcer. In the early stage, 

 before an ulcer is formed, there is proliferation of the 

 cuticular cells leading to the formation of papules ; later 

 this proliferation extends a little in advance of the edges 

 of the ulcer. The cells composing the granulation tissue 

 are almost exclusively of the mono nuclear type. They 

 are large rounded cells with prominent nuclei, and are 

 apparently of endothelial origin. The appearance is thus 

 very different from that of simple ulceration of the skin, 

 in which polymorphonuclear cells predominate. A few 

 of these cells also occur in Oriental sore, but giant cells, 

 such as those seen in tubercular and some syphilitic 

 affections of the skin, are not met with. 



Scattered throughout the granulation tissue, but chiefly 

 contained in the large mononuclear cells, are vast numbers 

 of parasitic organisms, very similar to those occurring in 

 kala-azar. These bodies were first described as occurring 

 in Oriental sore by Wright, of Boston, in 1903. He 

 discovered them in an ulcer contracted in Armenia some 

 months previously. The discovery was confirmed, as 

 regards similar sores contracted at Delhi, Lahore, Quetta, 

 and other places in Northern and Western India, by James 

 in 1904, and as regards Egypt by Billot, and by Darling 

 and others in the South American form. The parasites, 

 Leishmania tropica, are indistinguishable morphologically 

 from those of kala-azar, a description of which will be 

 found on p. 165. James described the occurrence in 

 some of the parasites of a third chromatin mass a rod 

 tapering towards the micronucleus and at right angles 



