ulcers occur about the knees and elbows, or larger ulcers 

 on the leg. The occurrence of these ulcers should 

 arouse suspicion of a systemic infection with the 

 parasite, for in Madras all cases affected with Noma or 

 Cancrum oris yielded parasites on splenic puncture. 



6. Skin lesions. Especially in advanced cases, 

 papular eruptions occur about the thighs and scrotum. 



7. Haemorrhages, epistaxis, petechiae, furfura, 

 etc. 



8. Oedema of the feet. Occasionally but not 

 constantly present. 



9. Pigmentation of the skin. Not usually in 

 excess of the normal. 



Technique. (l) For puncturing the spleen use a hypodermic 

 needle. Boil it previously in normal saline, or in normal saline 

 containing 0*1 per cent, ammonium oxalate. Puncture between the 

 ribs if the splenic enlargement is not great, otherwise where it is 

 most prominent. Make a number of dry and wet films. (2) To 

 examine the granulation tissue of ' Tropical ulcer ' snip off with a 

 curved scissors pieces of tissue from papules or ulcers. Crush a 

 fragment on a slide by means of another slide and make thin smears. 

 Fix other pieces for section cutting (p. 44). 



Examine films made by splenic puncture and 

 in stained specimens (Romanowsky) ; observe the 

 following characters of the parasite (PI. IV) : 



1. The presence of small round or oval bodies 

 containing two chromatin masses a large and a small. 

 These are so distinctive that they cannot be mistaken, 

 and could not possibly be confused with platelets 

 (Figs. 1-6). 



2. Observe that some of these bodies are free 

 but that the majority occur in leucocytes, and in 

 fragments of the cytoplasm of splenic cells (matrix 

 of Ross, zooglea of Manson), which have a close 

 resemblance to unaltered red cells (Figs. 12-14). 



