119 



rations of different sizes from three 

 to ten centimetres in diameter. Ulcera- 

 tions generaiiy rounded and covered 

 witli u dark yellow and adhering crust. 

 Below tlais crust surface was rough and 

 purulent. Ulcerations bled with ease, as 

 soon as the crust was removed and the 

 patients complained of acute pains. In- 

 guino-crural and epitrochlear ganglia 

 swollen in size. 



On glans a quite noticeable white 

 scar, from a chancre in the patient's pre- 

 vious his'ory. Smears made with pieces 

 of ulcers and stained by GíEMSA pro- 

 cess, revealed numerous leishmanias, ei- 

 ther isolated in a microscopic field or 

 else in great numbers parasiting big 

 raiononuclear leucocj'îes and heaped up 

 m their protoplasm, leaving on 

 sight the intensely stained nucleus 

 and the outlines of the protoplasm. 



In symbiosis with the leishmanias 

 could he seen in the microscopic field 

 spirilla and fusiform bacilli. "We have 

 already seen this fuso-spirillar symbio- 

 sis in other lesions be.sides angina and 

 oriental sore, such as ulcerated epithe- 

 lioma, blastomycosis, syphilitic or sim- 

 ple chancres etc. 



It is probably a factor of contami- 

 nation, which the ulceration, giving it 

 immedialel}' a phagedenic character and 

 the treatment is very much helped by 

 the local ministration of antiseptics. 



We made a biopsy of the ulceration 

 of the nose and the small piece removed 

 was fixed in SGHAUDINN sublimate- 

 alcohol and embedded according to the 

 ordinary methods. The sections stained 

 with GlEMSA, hematoxylin-eosin and 

 VAN GlESON showed numerous leish- 

 manias, sometimes isolated and bet- 

 ween the tissiie cells as those emigra- 

 ted from the blood or, more commonly, 

 parasiting the great mononuclear leu- 

 cocytes. 



The patient died when still under 

 treatment and right in the beginni.ig of 

 it from a process of acute miliary tu- 



berculosis as will be seen in the pro- 

 tocol. Let it be remarked in passing, 

 that leishmaniosis in its mucous form, 

 the most serious and resistant to treat- 

 ment, with its frequent recidives destroy- 

 ing the cartilages of the nose, hindering 

 j thereby normal breathing, making brea- 

 j thing through the mouth necessary and 

 I attacking all the organs found at the 

 j back of the mouth (tonsils etc.) 

 I which are the means of defense of the 

 j body places the human body in a state 

 I of inleriorily rendering the invasion by 

 I other diseases whose saprophytic germs 

 I are fomul under normal conditions in 

 I tlie moDth (tuberculosis, diphtheria etc.) 

 I easy. 



Leishmaniosis is not a disease pro- 

 j ducing by itself death; generally the 

 j cases become chronic and when death 

 I ensues it is very often due to tubercu- 

 losis which finding a favourable ground 

 has developed meanwhile. 



Aiitopsfj : — Diagnostic: Tuberculosis 

 miliaris acuta pulmomnn, hepatis et 

 lienis. Lymphadenitis tuberculosa me- 

 saraica. Enteritis tuberculosa ulcerativa. 

 Pharyngitis ulcerativa. Laryngitis ulce- 

 rativa. Oesophagitis ulcerativa. Trachei- 

 tis ulcerativa.Sj'philis. Cicatrix penis. Pe- 

 risplenitis chronica. Pleuritis adhesiva 

 sub-acuta. llypertrophia ventriculi utrius- 

 qr,e. Aortitis. Cladis soepti nasis. Ulcus 

 alae sinistrae nasis. (Leishmaniosis). 

 Granuloma nasis (Leishmaniosis). Ul- 

 cus labii superioris (Leishmaniosis). 

 Atrophia renum. Ankylostomiasis. 



Cadaver of male sex, rather ema- 

 ciated. Cutaneous teguments black. No 

 oedema on lower limbs. Irregular distri- 

 bution of hair. Superficial cicatrix of 

 balano-preputial ridge. Inguino — crural 

 ganglia enlarged, gliding imder fingers 

 when felt. Small tension of abdomen. 

 Intercostal spaces depressed. Upper lip 

 with a loss of substance affecting the 



