282 
Oriental Sore 
must certainly happen that a child will inoculate itself at some other 
place by conveying the organisms on its fingers. Such infection could 
also very readily be produced by the house-fly, though it has not been 
demonstrated experimentally. These secondary sores are liable to occur 
only because the immunity against the sore parasite is not complete. 
Sometimes the secondary sore will develop towards the closing period 
of the first. It is difficult to explain such cases on the theory of immunity. 
If it is an immunity which has caused the first sore to disappear, then 
one would expect this to be sufficient to prevent the development of 
the secondary sore. However, it is possible that the virulence of the 
parasites of the first sore has become so attenuated that they cease to 
multiply, while the freshly inoculated pax’asites of the secondary sore are 
of sufficient vii’ulence to withstand the partial immunity which dissipated 
the first. I have the following history of the disease in a European: 
A sore appeared on the right wrist. This followed the usual course and 
disappeared in about one year. Soon after the disappearance of the 
first a second sore appeared on the left elbow. This persisted for a 
similar period, after which no fnore developed and the person has 
remained free since. In other cases a sore will develop up to a certain 
stage and then commence to shrink and show signs of disappearing, and 
just when the patient is congratulating himself that the trouble is 
nearly over, it will break out again, extend and exceed its original 
dimensions. With these exceptions, one single attack lasting about a 
year is the rule, while the healing of the sore appears to be brought 
about by an immunity against the specific organism acquired by the 
person infected; such an immunity being sufficiently lasting to protect 
the person from further attack for the rest of life. 
Symptoms. Apart from purely local symptoms due to the sore, it is 
impossible to trace any constitutional disturbance. The fact that 
nearly all sores are in very young children renders the detection of such 
symptoms difficult, as any slight disturbance in health can at this age 
be attributed to the common ailments of childhood. The onset of the 
disease is so insidious that the first papule is not considered to be a true 
sore till its persistence compels this view to be taken. Mild fever, 
feelings of malaise or intestinal derangement, or other slight symptoms 
which might be supposed to accompany such a benign infection, would 
most probably be looked upon as one of those slight disturbances to 
health so common in all hot countries. In the case of the child with 
twenty-three distinct sores, recorded above, there was nothing to 
indicate, apart from the sores, that the child was in any way abnormal. 
