C. M. Wenyon 
283 
It has been suggested that this disease is a general one, and that a sore 
is merely the local manifestation of a general infection as in the case of 
syphilis. If this is true, there is however this difference; whereas in 
syphilis the chancre indicates a severe general infection accompanied by 
various definite symptoms, and a corre.sponding distribution of the specific 
parasite throughout the body, the sore is accompanied by no such 
constitutional disturbances, or such as are too slight to be detected, and 
the sore parasite is limited to the sore and does not extend to other parts 
of the body. 
The local symptoms are due to the presence of the sore. In the 
early stages the papule may cause slight iri’itation and itching, and be 
feebly tender on pressure. There is only slight surrounding inflamma¬ 
tion of the skin, except in some of the cases, with a secondai-y bacterial 
infection. There is little pain, and the sores are not remarkably tender 
unless it has formed over a bone such as the tibia or olecranon process. 
The discharge from the ulcerating sores is often very foul and exceedingly 
unpleasant, not only for others, but for the patient himself, who frequently 
is unable to remain in a room, but has to seek refuge in the open air. 
Occasionally, in septic sores, there is pain and tenderness in the 
lymphatic glands receiving the lymphatics from the infected area of 
skin. 
The impossibility of performing autopsies on human beings in 
Bagdad is a misfortune, as from this source much light might be thrown 
on the disease. It is very important to know whether the parasites are 
to be found in the internal organs as in Kala azar, or whether thev occur 
in the lymphatic glands. Without autopsies it is impossible to decide 
these questions. Repeated examinations of the peripheral blood of 
infected persons have failed to confirm the observations of Neumann 
made on a single case under his care in Heidelberg, that parasites occur 
occasionally in the circulation. Equally unsuccessful were the attempts 
to obtain cultures by inoculating tubes of blood agar with blood taken 
from the finger or ear of persons suffering from the sore. 
Treatvient. Very little can be done in the way of treatment and 
though many medicaments have been tried, they have no appreciable 
effect on the duration of the malady. Excision of the sore has been 
attempted, and with success. The sore must be treated as a malignant 
growth and removed entire with u good margin of healthy flesh, great 
care being taken to prevent contamination of the wound by the organisms 
of the sore. Such a procedure is hardly practicable on the face and 
would probably lead to more extensive scarring and deformity than if 
