2170 



ULCERATIONS 



similar at the very beginning from mosquito-bites, for which they 

 are often taken by the patients. The spots, however, instead of 

 slowly fading, become red and shotty, with an inflamed areola, 

 which later becomes markedly indurated. The papules slowly 

 enlarge to the size of a pea or bean; the surface gradually loses its 

 smooth and shiny appearance, and becomes covered with small thin 

 scales. After a period of time, somewhat variable in length, but 

 generally not exceeding three to four months, the ulceration of the 

 nodule begins. At first the ulceration is very superficial, and 



Fig. 853. — Oriental Sore in a Persian Soldier. 

 {From a photograph of Drs. A. Bussiere and Nattan-Larrier.) 



exudes a yellowish secretion, which soon dries into a hard, adherent, 

 darkish scab. Underneath the scab the ulcerative process and 

 disintegration of the nodule continues slowly to spread. The 

 tissues surrounding the ulcers may become oedematous. If later 

 the darkish scab be removed, an ulcer is seen, about an inch or 

 more in diameter, with sharp-cut, jagged edges and irregular fundus, 

 with reddish-yellow, sometimes fungating granulations. The ulcer 

 is generally indolent, or but slightly painful. The neighbourirg 

 lymphatic glands are not, as a rule, sensibly enlarged, unless there 



