MUCO-CUTANEOUS LEISHMANIASIS (ESPUNDIA) 2179 



has been recorded by Alfr. da Matta. In the last stage the patient 

 becomes cachectic, and his appearance may be that of a carcino- 

 matous patient. 



Prognosis. — Beforethe introduction of tartar emetic by Vianna the 

 prognosis used to be very bad, though occasionally when the diag- 

 nosis was made as soon as the primary cutaneous lesion appeared, 

 and this was destroyed, the further progress of the disease was 

 prevented. 



Diagnosis. — The disea,se is distinguished from the usual type of 

 dermal leishmaniasis (Oriental sore) by its very long course. More- 

 over, the latter invades the oral mucosa only exceptionally, though 

 cases have been reported by Cardamatis in Greece, and Lacava and 

 Gabbi in Italy. From blastomycosis it is distinguished by the 

 presence of a leishmania, and absence of yeast-hke or monilia-like 

 fungi. From syphilis it can be diagnosed by the uselessness of the 

 mercurial and salvarsan treatment; from morva by the absence of 

 B. mallei Loffler and Schiitz; moreover, morva is very rare or absent 

 in those regions where espundia occurs. The condition is distin- 

 guishable from tuberculosis by the different histological lesions; 

 from framboesia by the absence of the framboesiform eruption on 

 the body, by the absence of the Treponema pertenue Castellani, and 

 by the uselessness of the salvarsan treatment. 



Treatment. — Tartar emetic, first used in the disease by Vianna, 

 is a specific. The usual i per cent, solution in saline or distilled 

 water, filtered through a Berkefeld candle, or sterilized in flomng 

 steam, is given by intravenous injection (5 to 10 c.c. per injection) 

 for several periods of five days each until twenty or thirty injections 

 have been given. The same solution may be used as a local applica- 

 tion to the sores, for syringing the nose, etc. 



Strong solutions or tartar emetic in powder form should not be 

 used, as they give rise to severe pain. 



Mild antiseptic mouth-washes such as diluted glycothymolin and 

 listerin or potassium permanganate (i in 5,000) should be freely used. 



According to Escomel, if the primary lesion be excised or destroyed, the 

 further course of the disease is prevented. 



Prophylaxis. — Abrasions, fissures, and any ordinary traumatic 

 small sores, should be kept well disinfected and protected with 

 antiseptic dressings, to prevent infection with the espundia virus. 

 Any insect bite should immediately be touched with tincture of 

 iodine. 



INDIAN ORO-PHARYNGEAL LEISHMANIASIS. 



Remarks. — It may be of interest to give a brief account of an 

 ulcerative condition of the throat observed by one of us in two 

 Europeans who had long been living in India. 



^ti3l05y. — In one of the two cases observed, scrapings from the 

 ulcers contained typical leishmania bodies very similar or identical 

 to Leishmania tropica and L. donovani. In the other — which was 



