C. M. Wbnyon 
277 
the summer months. This of course refers to the first inoculation, as 
secondary inoculations or autoinoculation may occur at any time of the 
year by the scratching of an already existing sore and the trans¬ 
ference of some of the organisms to an abrasion on some other part of 
the body. 
Position of the sore on the body. The strict limitation of the sore 
to exposed surfaces of the body has been a long recognised fact. This 
is one of the chief arguments in favour of insect transmission of the 
disease. In very young children less than twelve months old, one 
rarely encounters a sore except on the face, a fact probably dependent 
upon the habit the people have of wrapping infants up so that the 
whole body is covered with the exception of the face. At an earlier 
age the face is usually covered also, so that the rarity of sores in 
children before the age of twelve months is easily explained. In older 
children the sore commonly occurs on the arm or leg, below the elbow 
or knee, though the face is still the most usual situation. In adults, 
almost invariably new comers, the disease appears with about equal 
frequency upon the face, arms, or legs. It is rare to find a sore on any 
other than the exposed parts of the body. I have seen a case in a boy 
about five years old where there was one sore on the buttock, and 
a second over the sternal end of the second left rib, and in another child 
age about three years, a sore near the umbilicus. I have been told of 
“ cases where “ sores ” (?) occurred in numbers all over the body, but it 
must be doubtful if such are true sores (due to Leishinania) as the 
disease can very readily be confused with other conditions, such as 
syphilis. 
Upon the face the sore appears usually upon the cheek or forehead. 
It commonly occurs on the end of the nose, producing an unsightly 
condition while it lasts though the permanent scarring is not in pro¬ 
portion to the temporary disfigurement. The sore more rarely attacks 
the lips, eyelids, and ears. I have not seen a case of sore on the scalp, 
neck, or on any of the mucous surfaces. On the arm the disease may 
appear on the elbow over the olecranon process, a position in which the 
sore is often very painful. More usually it is below the elbow and 
frequently occurs upon the fingers, producing a great enlargement of 
these. On the leg the favourite site is on the outer side just above the 
ankle joint. 
This practically constant appearance of the sore on the exposed 
surfaces of the body can hardly be explained by any other assumption 
than that the disease is transmitted by some biting insect or fly which 
