2172 



ULCERATIONS 



and later by Archibald in Egjrpt and the Sudan, so called from the 

 peculiar verrucose appearance of the lesions. 



3. The keloidform variety. This is a non-ulcer ative type described 

 by Cambillet, Balfour, and Thomson, characterized by the presence 

 of pinkish nodules, somewhat keloid-like, which never ulcerate. 

 For this variety Balfour suggested the name ' Leishman's nodules/ 

 and Brumpt created a new species for the leishmania found in them 

 — L. nilotica Brumpt, 1913. 



4. The frambcesiform variety. This is characterized by the pres- 

 ence of numerous nodules capped with crusts and resembling yaws 

 (see Fig. 854). It is fairly common in the West Indies, where it is 

 known by the name of ' forest yaws,' ' Bosch-Yaws,' or ' Bush-Yaws.' 



5. The papillomatous variety. This is found in South America, 

 but very similar types seem to have been met with in North India. 



It is characterized by the presence 

 of papillomatous masses, which 

 are generally found on the lower 

 limbs, and are designated by the 

 Amazon natives with a word 

 which means sponge. The natives 

 believe that the same affection 

 attacks horses, mules, and 

 donkeys. 



This variety runs a much longer 

 course than the common type of 

 Oriental sore, lasting ten to fifteen 

 years, and with very little or no 

 tendency to spontaneous cure. It 

 is probably due to a species of 

 leishmania biologically different 

 from L. tropica, and most 

 authorities consider it to be due 

 Fig. 854.- Forest Yaws. to L. tropica var. americana, - 



(From a photograph by Sambon.) the variety of leishmania which is 



the cause of espundia (see below) . 



6. The deep ulcerative variety. This is found in South America, 

 and is characterized in most ' cases by the presence on various parts 

 of the body of deep large ulcers running a very long course and with 

 practically no tendency to spontaneous cure. In some cases the 

 condition is localized to the ear, which may become perforated 

 (oreya de los chicleros). One such case has recently been recorded 

 by Low. This condition is often in reality the first stage of espundia, 

 and is due to L. tropica var. americana (p. 380). 



Diagnosis. — The diagnosis of all types of cutaneous leishmaniasis is 

 made with absolute certainty only by examining microscopically the 

 suspected lesions and finding the leishmanias. In numerous cases of 

 the most common variety — Oriental sore sensu stricto—the diagnosis 

 can often be made clinically, taking into account the following data :■ — 



I. The patient comes from or is living in an affected area. 



