ON KALA-AZAR 129
inoculation into the skin, as might occur amongst demon- strators of anatomy, butchers, and handlers of hides, one got a strictly local manifestation, in the form of a reddened mass of granulation tissue usually capping the dorsal surfaces of the hands or fingers, the so-called 2>os^- mortem wart, or the verruca norvegica of Wilks. That lesion so closely resembled Oriental sore that the latter had indeed been taken for a form of cutaneous tubercu- losis, and Lewis and Cunningham had even proposed to call it lupus endemicus.
In anthrax they had another suitable example. There aiso the so-called "external anthrax" or "malignant pustule " might remain localized and curable. The regions of the body most frequently attacked were, as in Oriental sore, the face, neck, and hands.
But perhaps the best example was that of vaccinia, a local manifestation of variola, usually conveyed to cattle during the milking process by farm hands previously employed in dressing horses suffering from "grease" or horse-pox. Local manifestations of small-pox could be reproduced in man by smearing the abraded skin with matter from pustules of either vaccinia, horse-pox, sheep- pox, or human variola, and the practice was almost as old as the history of mankind. The Chinese practised variolization at least 3,000 years ago, and vaccination was known and practised in England, Germany, and other countries long before Jenner advocated its general use as a prophylactic against the deadly general infection.
Just as small-pox was inoculated in order to obtain a local and mild manifestation of the disease that might confer protection against the far more dangerous general infection, so, from time immemorial, in certain places, had Oriental sore been intentionally transmitted by inoculation to guard against more fearful consequences.
