ORIENTAL SORE 



217X 



is a secondary pyogenic infection. The examination of the blood 

 taken from the finger shows often a distinct mononucleosis, and the 

 coagulability is generally increased. The total number of leucocytes 

 may be normal, or there may be leucopenia, or during the attacks 

 of fever leucocytosis. In the blood taken from non-ulcerated 

 lesions the mononucleosis is much more marked. 



Healing generally sets in after six to twelve months by granula- 

 tion, which begins in the centre of the ulcer, the unhealthy-looking, 

 large, yellowish granulations giving place to healthy ones. A 

 whitish or pinkish, often depressed and disfiguring, scar remains 

 at the seat of the ulceration. After^.cicatrization, the sore may 

 break down again. 



Oriental sore may be single or multiple. Two or three are fre- 

 quently found on the same patient, but occasionally there are many 

 more, and may spread to the mucous membranes of the mouth and 

 nose. The sores are auto-inoculable by scratching. 



The seat of the ulcers is generally on uncovered parts — feet, 

 legs, hands, arms, face. They are very seldom observed on the 

 palms, soles, or scalp. The affection attacks people of any race, 

 sex, and age, if they expose themselves to the infection. 



Course. — The length of the incubation period is not known with 

 certainty. It is generally stated that it varies between a few days 

 and six weeks. Manson, however, has observed that it may be 

 as long as five months, and Wenyon, who inoculated himself, ob- 

 served that the first skin lesions appeared six and a half months 

 after inoculation. Manson in one case made the interesting observa- 

 tion that the appearance of the sore was preceded several months 

 by a fever of an irregular remittent type, not influenced by quinine, 

 and having some features of the fever of Indian kala-azar. This 

 fever was also noted by Marzinowsky and Wenyon, who inoculated 

 themselves experimentally. Attacks of irregular fever during the 

 incubation and the course have been recorded by several other 

 authors. During one of these febrile attacks Neumann observed 

 Leishmania tropica free in the liquor sanguinis of the patient. 



The duration of the eruption varies from four or five months 

 to twelve months and more. Relapses may occur, but true rein- 

 fections are rare. 



Clinical Varieties. — The following clinical varieties may be dis- 

 tinguished : — 



1. The common variety — Oriental sore sensu stricto — to which the 

 description given above refers. This variety, which is the usual 

 type met with in Asia, Africa, and South Europe, while compara- 

 tively rare in America, is characterized by the presence of one or 

 several nodules, which slowly ulcerate, with or without symptoms 

 of general infection, such as fever and enlargement of the spleen. 

 Very rarely, in addition to the cutaneous nodules, there may be 

 ulcerative lesions on the mucosa of the mouth and nose, as noted 

 by Cardamatis in Greece and Lacava and Gabbi in Italy. 



2. The verriicose variety, described by Ferguson and Richards, 



