Page:Tropical Diseases.djvu/257

XI] been recognized in India that in districts where kala-azar is common oriental sore is rare. Recent work has shown that this is partially true for the Mediterranean area also. In Teheran the dogs are found infected with dermal leishmaniasis, and a general infection combined with cutaneous lesions has been produced in mice by intravenous injections of cultures of Leishmania tropica (the parasite of oriental sore), and sores in monkeys by cutaneous inoculation of cultures of Leishmania donovani.

Synonyms.—— Tropical sore, bouton d'Orient, Delhi boil, etc.

Definition.—— A specific ulcerating granuloma of the skin, endemic within certain limited areas in many warm countries. It is caused by a species of Leishmania, and is characterized by an initial papule, which, after scaling and crusting over, generally breaks down into a slowly extending and very indolent ulcer. Healing after many months, it leaves a depressed scar. The sore is inoculable and, usually, protective against recurrence. Geographical and seasonal distribution.—— Among the endemic places may be named Morocco, the Sahara (Biskra, Gafsa), the Niger, Egypt, Crete,Cyprus, Asia Minor, Syria (Aleppo), the Soudan, Mesopotamia (Bagdad), Arabia, Persia, the Caucasus, Turkestan, India (Lahore, Multan, Delhi, etc.). Juliano describes the disease as being common in Bahia, Brazil, and cases are reported from Bolivia, Peru, Panama, and French Guiana—— where it is called "pian bois," " bosch-yaws," etc. The name oriental sore, suggested by Tilbury Fox, is therefore no longer quite appropriate.

Locally, oriental sore is often called after some town or district in which it is specially prevalent; thus we have Delhi boil, Bagdad boil, "clou de Gafsa" and so forth. It is much more common in cities than in the country. In Bagdad few escape an attack; visitors of a few days only are almost certain, at particular times of the year, to contract it.