2i8o 



ULCER A TIONS 



the first case seen, and clinically identical to the second — no leish- 

 mania was found, but the patient had to go back to India, and no 

 repeated examinations could be carried out. We are inclined to 

 think that it was of the same nature. The condition may have 

 been kala-azar, with ulcerations on the throat, though this mani- 

 festation of kala-azar has never been described; moreover, the 

 general health was not so affected as in kala-azar of long standing. 

 Tt was not Oriental sore with complications on the oral mucosa,^ as 

 the skin had never been affected; moreover, Oriental sore does not 

 run such a long course. It was not espundia, as there were no 

 cutaneous lesions and the ulcers were not framboesiform. 



Symptomatology. — In the case in which leishmania bodies were 

 found there was no history of syphilis or of any ulcerative lesion on 

 the skin. He had been residing for a long time in India, and when 

 he consulted one of us at Colombo, was going on a long holiday. 

 He was a tall, rather stout man (European) of thirty-eight years 

 of age, in apparently good general health, but he complained of 

 intractable ulcers on the pharynx and soft palate, which, according 

 to him, had been present for the last nine years, and which gave 

 a certain amount of discomfort, though they were not very painful. 

 No enlarged lymphatic glands could be detected. The local ex- 

 amination showed the presence of several ulcers on the posterior 

 wall of the pharynx and on the soft palate; they were of various 

 sizes, but not very large, mostly i to J centimetre in diameter; 

 they were roundish, and some of them not very deep. Some were 

 covered by debris; none had a framboesiform appearance. The 

 patient had been treated in various ways, including a very energetic 

 antisyphilitic treatment, without any effect. The microscopical ex- 

 amination of scrapings from the lesions showed leishmania bodies, 

 apparently very similar or identical to Leishmania donovam. 

 On inquiry the fact was elicited that the patient had been occasion- 

 ally suffering from attacks of fever, believed to be malaria, for the 

 last five years. The physical examination of the patient revealed 

 nothing abnormal, but the spleen on percussion appeared to be 

 slightly enlarged, and on deep inspiration was just palpable. 



In a clinically identical condition seen in a previous patient no 

 leishmania was found in the ulcers, but no repeated examinations 

 could be carried out; he admitted having had many attacks of 

 what he called ' malarial fever.' In that case the spleen was much 

 enlarged, though the examination of the blood revealed absence of 

 malarial parasites and pigment. 



Prognosis. — The local ulcers were most intractable. The general 

 health did not seem, however, to be very markedly affected. 



Diagnosis. — This is based on the microscopical examination. 

 Care should be taken to make a deep scraping of the ulcer. 



Treatment. — This should be the same as for espundia. 



