Granulation Summer Sores with Fungi. 45 



where it is known as leeches, bearing reference to supposed 

 leech bites, and indicating a relation to poqds, lakes, rivers and 

 swamps in which leeches are found. Cases occur over the whole 

 Atlantic slope and as far north as St. Paul, Minneapolis and New 

 York. An occasional case is presented at the college clinic at 

 Ithaca. As in Asia and Europe the affection follows the bottom 

 lands of rivers, low, damp prairies, swamps, lakes and ponds. 

 Cases seen on higher, drier lands are usually isolated, and at 

 times imported from an infected district. 



Symptoins. Lesions. In the more temperate regions the 

 lesions are usually confined to the skin, yet this is not con.stant, 

 and even at Ithaca we have seen the morbid process extend 

 downward and inward, implicating the lateral cartilage so that a 

 portion had to be excised. In damp tropical regions the lesions 

 are much more extensive. Writing of Florida, J. H. Neal says 

 it begins " as a grain of shot lodged beneath the skin. In eight 

 or ten days the skin sloughs off centrally over this hard spot, 

 leaving a bloody, bruised-like surface, exuding serum and blood, 

 no pus. This rapidly grows in size until in a few weeks there is 

 a raw surface from four inches to one foot square. An examina- 

 tion will show usually a mass of yellow, gritty growth, coral-like 

 in shape, embedded in a mass of bruised bloody tissue, dark in 

 color and the edges roughened, elevated above the skin and the 

 skin decaying at the outside of the ulcer. The invaded tissues 

 decay slowly and apparently without pain. I have seen hoofs 

 cut off, the abdomen opened, the eyes eaten out, the teeth de- 

 stroyed, etc." 



As seen at Ithaca the fungous growth has appeared mainly on 

 the limbs and trunk in spots varying from one-half an inch to 

 three inches in diameter, the soft spongy, .grayish yellow mass 

 rising above the level of the skin, rarely gritty, but soft and 

 friable, easily scraped down to the level of the skin, and leaving a 

 dark red bloody surface. When thus scraped off it grows rapidly 

 to its former level or beyond, and though it may heal up during a 

 cool period and above all in winter, yet it starts into renewed 

 growth on the occurrence of hot summer weather. 



In Florida specimens Dr. Fish found the well developed nodule 

 {kunkur) more or l&ss completely detached from the surrounding 

 tissues. In the early stages it was soft and easily cut ; later hard 



