MUCO-CUTANEOUS LEISHMANIASIS {ESPUNDIA) 2177 



larynx, and trachea. The oesophagus was also affected. The 

 organs presented amyloid degeneration. 



The histopathology of the disease has been well investigated by 

 Breda, Escomel, De Amicis, Verrotti, Splendor e, Carini, and recently 

 very completely by Laveran and Nattan-Larrier. The lesions do not 

 show any characteristic histological feature, theepithehal strata have 

 disappeared, and are substituted by a fibro-leucocj^ic membrane ; 

 there is a large amount of granulation tissue, with numerous mono- 

 nuclear leucocytes and plasma cells; a few macrophages may be seen. 



Fig. 856. — EsPUNDiA. 

 (After Splendore.) 



Splendore has occasionally seen giant cells; no cell nests have 

 been observed. The stroma consists of some fibrils, which are 

 stained with difficulty. The lesions are not very vascular. 



Communicability. — The infection may be conveyed by direct 

 contact from person to person, the virus being absorbed through 

 some abraded surface, fissure, or small wound. It may also be 

 transmitted probably by some blood-sucking insect, most patients 

 stating that the first lesion appeared at the place where they had 

 been bitten by some insect. Mosquitoes, sand-flies, certain ticks 

 and certain flies (especially tabanid) have been inculpated. 



As regards the reservoir of the virus, certain observers suspect dogs, in which 

 occasionally a similar or identical affection to the human one may be found. 

 In Paraguay there is a popular belief that the rattle-snakes are the reservoir 

 of the virus. 



Parling and Townsend have brought forward the hypothesis that the 



137 



