merge. These sores, usually about an inch in diameter, may come, in some instances, to occupy an area several inches across.
After a variable period, ranging from two or three to twelve or even more months, healing sets in. Granulation is slow and frequently interrupted. Often it commences at the centre whilst the ulcer may be still extending at the edge; often it is effected under a crust. Ultimately a depressed white or pinkish cicatrix is formed. Contraction of the scar may cause considerable and unsightly deformity.
Oriental sore may be single or multiple. Two' or three sores are not uncommon; in rare instances as many as forty have been counted on the same patient. They are mostly situated on uncovered parts hands, feet, arms, legs, and, especially in young children, on the face; rarely on the trunk; never on the palms, soles, or hairy scalp. Seidelin, Darling, and Connor have described as occurring in South America oriental sores with a predilection for the margins of the ears.
Dr. Sturrock, who practised in Bagdad for four years, informs me that in rare instances the disease recurs more than once, but, as a rule, the sores of the second attack do not break down. He has also seen a chronic type of the disease, which may recur and persist for several years and be associated with deposit in the testes, in mucous membranes, as well as with a chronic form of dactylitis.
In a very few instances the initial papule does not proceed to ulceration, but persists as a scaling or scabbing, non-ulcerating, flattened plaque just as sometimes happens in the case of the primary sore of syphilis. Sometimes the ulcer is quite superficial, an erosion rather than an ulcer. Occasionally, from contamination with the virus of some other infectious acute inflammatory skin disease, the primary lesion may become complicated, and perhaps a source of serious danger. Otherwise, oriental sore is troublesome and unsightly rather than painful or dangerous.
According to Nattan-Larrier there is a mononuclear leucocytosis in this form of leishmaniasis similar to that in kala-azar.
