ORIENTAL SORE 



2167 



published a most useful and complete treatise on the malady and 

 other leishmaniases. 



Geographical Distribution. — The disease is endemic in many 

 tropical and subtropical regions. It is found also in temperate 

 zones. In Africa it is found in Morocco, Tunis, Tripoh, Algeria, 

 and Sahara (Biskra, Gafsa), Egypt, Sudan, Congo, West and East 

 Africa, and South Africa; in Asia it is common in Syria and Asia 

 Minor, in Mesopotamia, Arabia, Persia, the Caucasus, Turkestan 

 (Tashkent), in the Turkmene district (Pendhe). It is very common 

 in some parts of India, especially along the Valley of the Indus, in 

 the Raj put ana States, and in the North- West Provinces (Delhi, 

 Multan, Lahore). In Europe the affection occurs in the Crimea, 

 Cyprus, Crete, and Greece. Cases have been reported by Gabbi, 

 Lacava, and others from Italy. It is known also in Brazil and 

 other countries of South America, and in French and British Guiana, 

 where it is known as Pian-bois, or forest yaws, and has been 

 observed by Darling in Panama, so that the name ' Oriental sore ' 

 is somewhat misleading, 



It is generally much more common in large towns than in the 

 country. In some cities it is so prevalent that even visitors of a 

 few days only may not escape it. Its occurrence appears to be 

 influenced by the seasons, as, according to Hirsch, in the tropics 

 it is most prevalent at the beginning of the cool season, and in 

 more temperate climates at the end of summer. Laveran 

 says that in Biskra, from September to October inclusive, 

 the slightest wound tends to become transformed into the 

 ' bout on.' In some years it has been found to be more prevalent 

 than in others. 



A peculiarity of the geographical distribution of the disease 

 is that in the countries where it is endemic its distribution is not 

 general, but is confined to certain districts only ; hence the numerous 

 local names given to the malady, as Aleppo boil, Bagdad 

 boil, etc. 



etiology. — ^The disease is caused by Leishmania tropica Wright, 

 1903. In the first edition of this book we expressed the belief that 

 future investigation would show that there are several varieties of 

 L. tropica, each giving rise to a slightly different chnical type of 

 the affection, and this has come true, several species and varieties 

 having been described, though not yet generally accepted. The 

 description of L. tropica and its varieties is found in Chapter XIX., 

 p. 378 . Nicolle and Manceaux, Laveran and others have occasionally 

 succeeded in producing in monkeys and dogs Oriental sore by 

 inoculation of cultures. Row, by inoculating cultures of L. dono- 

 vani, has produced cutaneous lesions in monkeys, but such lesions 

 differ histologically from true Oriental sore. 



Mesnil, Nicolle, and Remlinger have observed the parasites to be present 

 occasionally in true polymorphonuclear leucocytes, besides being found in 

 the mononuclear leucocytes as usual. Mesnil has observed in some cases 

 a t5^ical ' bacillary ' form. 



