Tropical Ulcer 569 



vani, but, finding that it was infectious for dogs, he came to 

 the conclusion that it was a separate species, and called it 

 Leishmania infantum. He also found that the dogs in Tunis 

 frequently suffered from spontaneous infection from this parasite, 

 and it is possible that it is from the dogs that the children become 

 infected. 



Further experiments with this parasite by Nicolle and Comte 

 have shown that in the form in which it occurs in the human spleen 

 it is capable of infecting monkeys, and Novy has succeeded in cul- 

 tivating the organism and infecting dogs with artificial cultures 

 containing its flagellate forms. 



It is now thought by many that infantile kala-azar and Indian 

 kala-azar are identical diseases, caused by identical parasites. In 

 considering the probable source of the disease Stitt* says: "It has 

 been suggested that the Mediterranean basin may have been the 

 original focus of visceral kala-azar and that it spread thence to India 

 by way of Greece and the Russian Caucasus, cases having .been re- 

 ported from districts which would join the two foci. Just as chil- 

 dren bear the brunt of malaria in old malarial districts and adults 

 suffer in places in which the disease has been more recently imported, 

 so by analogy we may consider the disease as of more recent intro- 

 duction in India. ... In the Mediterranean basin there is a 

 natural canine Leishmaniasis and some think the human form may 

 be contracted from the dog through the medium of the flea." 



TROPICAL ULCER 



Leishmaota Furunculosa (Firth) 



In India, northern Africa, southern Russia, parts of China, the 

 West Indies, South America, and, indeed, most tropical countries, 

 a peculiar intractable chronic ulceration is occasionally observed,, 

 and is variously known as Tropical ulcer. Oriental sore, Biscra boil, 

 Biscra button, Aleppo boil, Delhi boil, Bagdad boil, Jericho boil, 

 and Buton d'Orient. It has long been known as a specific ulcerat- 

 ing granuloma. The lesions, which begin as red spots, develop into 

 papules which become covered with a scaly crust which separates, 

 leaving an ulcer upon which a new crust develops. The lesion 

 spreads and is much larger when the crust again separates. A 

 purulent discharge is given off in moderate quantities and the 

 ulcer becomes deep and perpendicularly excavated. It lasts for 

 months — sometimes a year or more — and gradually cicatrizes, 

 forming a contracting scar that is quite disfiguring when upon the 

 face. The lesions may be single, though they are commonly mul- 

 tiple, as many as twenty sometimes occurring simultaneously. It 

 is thought that recovery is followed by immunity. 



* Diagnosis and Treatment of Tropical Diseases, iqi4i P 75- 



