MUCO'CUTANEOUS LEISHMANIASIS {ESPUNDIA) 2175 



and then applies thoroughly a 50 per cent, lotion of chininum bimuriaticum 

 daily. He says recovery takes place in between seven to eleven days. 



Schulgin advises the freezing of the boil with ether. He used this method 

 in 300 cases with good results. 



Several French writers advise the use of permanganate of potassium, at 

 first in powder form, and later as a 5 per cent, ointment. 



Duncan advised placing a thin piece of lead over the ulcer, and then ban- 

 daging up. 



Emily recommended the repeated applications of boric acid. 



Oudiourminsky has applied to the treatment of Oriental sore Bier's stasis 

 method, apparently with good results. 



Chulguine recommended soaking the sore with a solution of methylene blue 

 (10 per cent.). 



Bussiere advised dilute tincture of iodine (10 per cent.). 



In other cases Bussidre and Nattan-Larrier advised excision of the sore. 

 Several physicians praise the use of silver nitrate. 



Castellani had some fairly good results in two cases by washing the sores 

 with a 5 per cent, solution of protargol, followed by the application of a 

 20 per cent, protargol ointment. The protargol ointment cannot be used 

 on Europeans when the face is afEected, as the protargol, after some time, 

 induces a discoloration of the skin. 



Lincoln and Aviss have obtained good results by painting the sores with 

 a native gummy fluid, sold in native bazaars under the name of ' raurath.' 



Timpano injects i c.c. daily round the sore of a i per cent, solution of 

 carboUc acid. 



Prophylaxis. — The disease being very contagious, and being also 

 probably spread by some blood-sucking insects, the slightest wound 

 and any insect -bite should be thoroughly disinfected with carbolic 

 acid 5 per cent., or tincture of iodine. 



MUCO-CUTANEOUS LEISHMANIASIS (ESPUNDIA). 



Synonyms. — Naso-oral Leishmaniasis, Uta, Chancre Espundique 

 d'Escomel (Laveran and Nattan-Larrier), Leishmaniasis cancerosa 

 (A. da Matta), Bubas Braziliana (Breda), Smith's disease, Breda's 

 disease, Bueno de Miranda and Splendore's Leishmaniasis, American 

 Leishmaniasis (Laveran and Nattan-Larrier). 



Definition. — A chronic ulcero-granulomatous affection of the skin 

 and mucosa of the mouth and nose due to Leishmania tropica Wright, 

 1903, var. amevicana Laveran and Nattan-Larrier, 1912. 



Historical. — Espundia seems to have been present in South 

 America since time immemorial. According to Tamayo espundia 

 lesions are depicted on certain water vases of the ancient Incas. 

 The malady has been known to local medical men for many years in 

 Peru and other parts of South America, though it was often confused 

 with framboesia and blastomycosis. Fairly good descriptions of the 

 malady were given by Smith in 1840 andTschudiin 1846, and later by 

 several other observers. In 1895-1896 Breda described in a series 

 of important publications the affection in Italy, in emigrants return- 

 ing from Brazil, under the name of Bubas Braziliana, and considered 

 it to be due to a bacillus the presence of which was confirmed by 

 Fiocca, who claimed to have reproduced the disease in the lower 

 animals by inoculating pure cultures of the organism. Breda's work 

 was confirmed by Verrotti and De Amicis. The term ' boubas/ 



