3 6y 
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 , purpura , 
etc. 
8. Oedema of the feet. —Occasionally but not 
constantly present. 
9. Pigmentation of the skin. —Not usually in 
excess of the normal. 
Technique.■ — (1) For puncturing the spleen use a hypodermic 
needle. Boil it previously in normal saline, or in normal saline 
containing on 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). 
