2178 



ULCERATIONS 



leishmania is an adaptation to man of insect flagellates. In this connection 

 one may quote the interesting observations made by Fantham and Porter, 

 Layeran and Franchini, who have succeeded in infecting mammalia with 

 certain flagellates found in fleas and mosquitoes (see p. 363). 



Symptomatology. — The incubation period is unknown. The 

 malady generally begins with a nodule on some uncovered part of the 

 body, which fairly quickly breaks down, and an ulcer is formed. 

 This first lesion is called by Escomel ' espundial chancre.' It is 

 mostly found on the forearms, legs, chest, trunk, or more rarely on 

 the face. The ulcer is generally atonic, roundish; there is very 



little or no pain, the fundus is 

 granulating, and there is 

 abundant purulent secretion 

 which dries up, forming thick 

 crusts. The ulcer after some 

 months, or even one or two years, 

 heals up, leaving a thick scar. 

 While this primary ulcer is still 

 open, but oftener after it has 

 healed, the characteristic lesions 

 occur on the mucosa of the 

 mouth and nose, with or without 

 the appearance of further 

 ulcerative lesions on the skin of 

 various regions of the body. 

 The lesions on the mucosa of 

 the mouth are ulcero-granulo- 

 matous, often framboesiform, 

 and may invade the hard and 

 soft palate, the gums, the labial 

 mucosa; they may form on the 

 palate a diffuse granulomatous 

 mass, with deep furrows. The 

 mucosa of the nose is very often 

 Fig. 857.— Espundia. A Sudan attacked, and destruction of the 

 Case. cartilages may take place, induc- 



(From a photograph by ing a marked deformation of 



Christopherson.) the nose. Alfr. da Matta has 



noted that the bones are not 

 destroyed; the skin is often oedematous, and patches of hard 

 oedema may be found below the eyes. The pathological process 

 may extend to the pharynx and. larynx. In some cases the 

 patient may become aphonous, and complains of great pain during 

 deglutition; his breath may be very offensive. There may be 

 serotine fever. 



The course is chronic; the disease may last for twenty to thirty 

 years, death being generally due to some intercurrent disease. In 

 a few cases the aSection may attack mucosae other than the naso- 

 oral, and pharyngeal. For instance, a case of vaginal leishmaniasis 



