— 638 — 
It is then we think évident that the skin disease and considé¬ 
ration is an example of what is called oriental sore but it appears 
to be a type not prone to ulcération (i). In this case some ol the 
growths hâve been présent for two years and even when punctured 
tend to scab and heal immediately. A portion only of the small 
growth showing the cell-nests was excised. The wound healed 
rapidly and now the nodule présents much the same aspect as it 
did before part of it was removed. In the father’s case the tu- 
mours hâve persisted unchanged, save as regards size, for 
six years, in the sister’s case for 4J- years. The patient has 
been very closely questioned on these points and is very definite 
in his reply. 
Has such a condition been previously reported ? W ith one exception we 
can find no record of such being the case. Some writers speak of the papu¬ 
les persisting for a long period (Cardamatis 15 mentions one of 2 1/2 months) 
and others of chronic papules which abort but in no instance is any indica¬ 
tion given that growths may attain the size they hâve done in this case 
without showing any sign, of breaking down (2). 
The exception mentioned is given bv Cambillet 16 who recently described the 
case of a small native boy in Algiers who presented on the right cheek a 
tumour with, to judge from the photograph given, must be almost iden- 
tical with the face growth in our case. It commenced as a small papule, 
increased in size until, at the time the paper was written, it measured 3 cen¬ 
timètres in diameter and showed no sign of ulcération or discharge. It had 
persisted for a year in this state. On puncture it vielded blood and « de 
petits grumeaux blancs » and in smears Leishmania tropica was found. He 
concluded that the case was one of « Bouton d’Orient » and certainly this 
term is much more applicable to his case and ours than that of oriental sore. 
The latter in any case is a misnomer as instances hâve been described from 
in Bahia by Juliano Moreira and recently from Bauru in Brazil by Linden- 
berg J7 , Carini and Paranhos 1S , who found Leishman bodies présent. 
We think cases of this kind might with advantage be termed 
Leishman nodules, as the word nodule sufficiently describes the 
growth and practically ail are agreed that L. tropica plays a part, 
and probably the chief part, in their etiology. It is true that 
some are apparently anxious to abolish the term Leishmania as 
applied to the parasite altogether and substitute for it 
Crithidia or Herpetomonas, but the word is now so familiar, and 
• 
(1) Is it not possible that the resuit dépends upon the reaction of the 
tissue to the virus ? If this be strong the epidermic layers thicken, if weak 
they are destroyed. It may be so or spécial forms of Leishmania mav pro¬ 
duce their own spécifie results, or again symbiosis with cocci or bacteria 
may play a part. 
(2) See, however, note at end of this paper. 
