2176 



ULCERATIONS 



used by Breda, was a rather unfortunate one, as it led to much 

 confusion, this term being generally used by tropical authors as a 

 synonym for framboesia, while the natives, as noted by Splendore 

 and others, use it indiscriminately to indicate various ulcerative 

 lesions of widely different nature. 



Escomel in 191 1 gave a very good description of espundia as 

 found in Peru. Further investigation has shown that the condition 

 found in Brazil is identical with that found in Peru. 



Bueno de Miranda and Splendore first found leishmania bodies 

 in the ulcerative lesions, Splendore making a very complete patho- 

 logical and clinical investigation of the condition, and succeeding in 

 experimentally inoculating it in monkeys. Splendore called atten- 

 tion to the fact that in cultures the flagellum of the Leishmania found 

 was generally longer than in L. tropica ; he observed also that with 



Giemsa's reagent the parasite stained 

 usually deeper than L. tropica. Laveran 

 and Nattan-Larrier have made an 

 important study of the parasite in tissues 

 sent to them by Escomel, and noting 

 the very frequent peculiarity of the 

 nucleus being flattened, have created a 

 new variety: L. tropica Wright, 1903, 

 var. americana Laveran and Nattan- 

 Larrier, 1912. Vianna had previously 

 created a new species, L. brasiliensis, but 

 this species has not been generally 

 accepted. More recent important re- 

 searches have been carried out by Horta, 

 Carini, Lindenberg, Rabele, Morales, 

 Darhng, Velez, Araujo, Chagas, Alfr. da 

 Matta, Aragao, Strong, Tyzzer, Brues, 

 Fig. 855.— Espundia. Sellards, Gastiaburu, Flu, Migone, 

 (After Splendore.) ' Torres, Christopherson, and many 

 others. 



Geographical Distribution. — The disease has been reported from 

 Peru, Brazil, Paraguay, Argentina, Colombia, and other parts of 

 South America. In Brazil it is especially common in the regions 

 between the State of St. Paulo and the State of Matto Grosso, near 

 the River Tiete; in Peru it is found in the regions of Caralaya and 

 Sandia, and close to the River Madre de Dios. Cases have been 

 reported from Panama and Mexico. It has been found in the 

 Anglo-Egyptian Sudan by Christopherson. 



.ffitiology. — The disease is due to Leishmania tropica Wright, 1903, 

 var. americana Laveran and Nattan-Larrier, 1912, which Vianna con- 

 siders to be a separate species, L. brasiliensis Vianna, 1911 (see 

 PP- 378, 379' and 380). 



Morbid Anatomy and Histopathology. — Escomel, in a chronic case 

 which died of cachexia, found the body extremely emaciated, and the 

 espundial lesions extending from the oral cavity to the pharynx, 



