A CASE OF PARASITIC GRANULOMA 211 



of their cases the parasites of Leishmania were either few or wholly absent from the lesions. 

 From their description it seems that this case is identical, clinically and pathologically, 

 with the cases met with in Lower Egypt. The warty type of growth appears to result from 

 the effects of friction and pressure, a fact well brought out in this case by the warty 

 nature of the growth situated behind the right external malleolus. 



The chief point of interest in the case was the fact th§,t Leishman bodies had undergone 

 a certain amount of development in the granuloma. As evidence in favour of this was the Evidence of 

 large size of some of the parasites and the presence of the " eosin body" in their cell "'^^'"^'"P- 

 cytoplasm. No reference to this stage of development has been made by Eow^ in his parasites in 

 recent and excellent work on the development of flagellated organisms from oriental sore, ''^'^ lesions 

 nor can one find any reference to it in the works of other observers. 



The well-marked local eosinophilia is difficult of explanation. Its existence is possibly 

 brought about by local irritation or may possibly result from a local toxin. 



The oval blue staining bodies that were found in smears made from the contents of the 

 papules and from the granuloma have been constantly found in the peripheral blood and 

 spleen smears of cases of kala-azar in the Sudan. One is rather inclined to look upon 

 them as indicative of degenerative blood changes rather than representing degenerated 

 forms of Leishman parasite. It is difficult to give a definite opinion concerning their 

 nature. In all probability they represent degenerated leucocytes or detached portions of 

 macrophages. 



The facts to which I have called attention may be thus summarised ; — 



1. The existence of a skin lesion in the Sudan allied to parasitic granuloma in which 

 developmental forms of Leishman bodies were present. 



2. The lesions show themselves clinically under two forms, one a slightly raised, 

 smooth patch with a pink centre which may or may not undergo ulceration ; the other a 

 warty form of growth resulting from friction or pressure. 



3. The histopathological changes in these lesions consist in an increase of the rete 

 Malpighi with a marked mononuclear cell infiltration of the subcutaneous tissues. 



4. The increased coagulability of the blood in the lesions. 



5. The presence of a marked local eosinophilia. 



' Bow, R. (1909), " DeTelopment of flagellated organisms from the parasite of Oriental Sore." Transactions 

 uf the Bombny Medical Congress. 



