196 TWO CASES OF NON-ULCEHATINO " OKIENTAL SORE " 



•• Large blue cell noted, wliicli stains a pale blue and contains a faint indication of what may be a 

 "^^ * , ,. lartje nucleus, althoui'h the latter stains more faintly than the cell protoplasm. Siinihir 



resembliii); r> " .11 



certain large blue cells liave been seen in splenic smears from cases of kala-a/ar. 



appearances m ^ jr^y^ forearm tjrowlh (subsequently excised). — Serum and a little l)lood were 



films obtained. There were many parasites in tlie mononuclears. Cells like degenerated 



leucocytes present. 



5. Right shoulder growth. — -Large numbers of parasites, both free and in tiic uiono- 



nuclears. Free clumps well seen. Degenerated white cells noted. 



G. Bight upper ariii growth. — Parasites very numerous, and are more spheiical in 



shape than in the other films. Mononuclears crowded with tliem. Vacuoles well marked. 



Rod-shaped, curved and spherical blepharoplasts. One form noted with two nuclei, a 



well-marked vacuole and a single curved blepharoplast. Tliis possibly represents a dividing 



parasite. Some very curious masses observed, either the result of fusion or of division. 



A small accessory growth situated close to the main tumour also showed the parasites. 



7. Growth on back.— A him made from the contents of tliis small growth showed no 

 parasites. 



8. Thigh growths. — Prom these tiny tumours oidy white cheesy sebaceous-like matter 

 was obtained. Films were made of it, and coccal forms of two kinds were found — one 

 resembling those seen in the smears of similar material from the neck growth and taking 

 on a deeper stain than the other, which consisted of small cocci of the usual type, 

 occurring largely as diplococci. 



Morphology of parasites. — -For the most part the parasites conform to the typical 

 L. tropica, and do not require special and detailed description. Practically all the forms 

 which have been described in oriental sore are present, and careful examination has not 

 detected differences, either in structure or arrangement. 



One need only mention the curved blepharoplasts, which struck us as peculiar, 



and the bodies staining a rose-pink. Examination of sections stained with eosin and 



liaematoxylin showed these latter to be plasma cells. 



ft'cuiiar The special form of large cocci found iu the growths containing no Leishmania and in 



found in the ''''*^ cheesy matter from the neck tumour also claims attention. They are four to six times 



shoulder the size of tlie small cocci present, and tend to stain very feebly at their centres. Indeed, 



some of them present centrally-placed unstained areas. They may occur in clumps or in 



pairs, and then may resemble in some measure huge gonococci. It is not likely that they 



are concerned with the Leishmania infection save in the way of symbiosis. Carter' has 



pointed out that L. tropica grows best in culture when associated with masses of cocci 



and bacteria. 



Although the suggestion, as regards the origin of the blue homogeneous masses, may 

 be correct, it is curious that many of them are very regular in outline, spherical or oval, 

 and resembling, as one may say for want of a better tei-m, "washed out" lymphocytes 

 whose nuclei have vanished. 



The white cheesy matter is no doubt sebaceous in origin. 



Histo-pathology of growths. — The first growth excised was a small one, accessory to 

 that on the left forearm, subsequently removed. 



The tissue was fixed in formol alcohol, hardened in alcohol, cleared in xylol, imbedded 

 in parafiBn and, after the usual treatment, stained in a variety of ways. The earlier sections 

 were slightly thick, and at first glance exhibited all the appearance of a squamous 



• Carter, Captain R. M. (September 11, 1909), "Oriental Sore of Northern India. A Protozoal Infection." 

 Briti.ih Sfediral Journal. 



