370 



larger ulcers on the leg. The occurrence of these 

 ulcers should arouse suspicion of a systemic infec- 

 tion with. the parasite, for in Madras all cases 

 affected with noma or cancrum oris yielded 

 parasites on splenic puncture. 



6. Skin lesions. — Epecially in advanced cases, 

 papular eruptions occur about the thighs and 

 scrotum. 



7. Haemorrhages, epistaxis,petechiae, purpura, 

 etc. 



8. Oedema of the feet. — Occasionally but not 

 constantly present. 



g. Pigmentation of the skin. — Not usually in 

 excess of the normal. 



Technique. — (i) For puncturing the spleen use a hypo- 

 dermic needle. Boil it previouslj' in normal saline, or in normal 

 saline containing o'l per cent, ammonium oxalate. Puncture 

 between the ribs if the splenic enlargement is not great, other- 

 wise 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. Imbed other pieces for 

 section cutting. 



Examine films made by splenic puncture and 

 in stained specimens (Romanowsky) ; observe the 

 following characters of the parasite (PI. VI) : — 



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). 



