ORIENTAL SORE 179 



to it. He believed it not to occur in the organism of 

 kala-azar, but it has since been shown to do so some- 

 times. In artificial cultures some of the parasites 

 develop a flagellum, just as the parasites of kala-azar do, 

 and, as a rule, the development in suitable media is 

 more rapid and the flagellates are larger. Men and 

 monkeys have been successfully inoculated and a local 

 lesion results sometimes six months or more later. With 

 the appearance of the local lesion there may be fever and 

 constitutional disturbance. In dogs these results vary, as 

 either a local lesion may result or a general disease of a 

 mild type. 



Etiology. From the great abundance throughout the 

 cells composing the granulation tissue of Oriental sore 

 of the binucleated organisms described by Wright and 

 James, it seems highly probable that these are the cause 

 of the disease. How they enter the body is unknown, 

 but long before their discovery the malady was considered 

 to be of a parasitic nature, and various parasitic bodies 

 were described as occurring in the affected tissues. 

 Among these mention should be made of the bodies 

 described in 1885 by Cunningham, and considered by 

 him to be monadina. From his description and figures 

 there can be little doubt that the bodies he considered to 

 be parasites were the large endothelial cells containing the 

 organisms described by Wright and James, the magnifica- 

 tion and staining methods at his command not admitting 

 of more precise differentiation. It may be added that 

 Cunningham's description of the histological appearances 

 of the sores is in close agreement with those of Wright 

 and James. 



While many of the earlier observers agreed that water 

 was in some way responsible for these sores, some attri- 

 buted them to its chemical contents, and others to its con- 

 taining parasites which were ingested or entered through 

 abrasions in the skin. Other suppositions are that these 

 sores are the result of bites of mosquitoes or of sandflies 

 or other biting flies, or that the parasites exist in the soil 



