SKIN SORES OF ESPUNDIA 89 



Espundia or American Leishmaniasis 



In many parts of Brazil, Paraguay, Bolivia, Venezuela, French 

 Guiana and other countries of tropical South America there 

 occurs a horrible form of Leishmanian ulcers which attack both 

 the skin and the mucous membranes of the nose and mouth 

 cavity. These ulcers do not grow to a limited size and then heal, 

 but slowly and constantly spread further and further, lasting 

 for a period of five, ten, fifteen or more years. The disease goes 

 by a great variety of local names of wliich espundia is the most 

 common. The best name of all is probably " American Leish- 

 maniasis." The name " buba brazihensis " has been given it by 

 some writers, but erroneously, since this name properly belongs 

 to another tropical disease, yaws. A few cases of Leishmania 

 ulcers have been observed in dogs in South America. Monkeys 

 can be experimentally inoculated. The organism causing these 

 intractable ulcers has been named Leishmania americana ihra- 

 ziliensis). It is a very minute animal, and is found usually in 

 rather scanty numbers in the sores; it can be distinguished 

 from the parasite of oriental sore, L. tropica, of which many 

 authors believe it is a mere variety, rather by its pathogenic effects 

 than by any peculiarity of form. Flagellated forms of the para- 

 site are occasionally found in the sores. 



Skin Sores. — The sores on the skin, which do not always 

 ulcerate, usually begin as one or two itching spots that seem to 

 be produced by the bites of insects. If the sores are of the non- 

 ulcerating type there is produced a great deal of red granular 

 tissue, raised slightly above the surrounding skin, and bleeding 

 easily. The surface, which is rosy in color, is rough, resembling, 

 according to one author, a cauliflower. An intolerably foul- 

 smelling fluid is constantly emitted which sometimes dries over 

 the sore to form a crust of varying thickness. The fluid given 

 off is infectious and starts new sores if it comes in contact with 

 any broken skin on the same or another individual. 



In the ulcerating type of the disease in the skin the same fetid 

 fluid is emitted, but instead of the sore being elevated, it is ex- 

 tensively excavated and has raised borders. Often an enclosing 

 crust forms over it and it is improperly called a " dry sore." In 

 this case the fluid is shut in between the crust and the sore and 

 causes even more intensive destruction of the tissues. Some- 



