37 1 
Large intestine .—Extensive multiple ulceration 
is almost constantly present. Fungating granulation 
tissue occurs in association with the ulcers. Purulent 
peritonitis, broncho-pneumonia, septic infarcts, are 
commonly met with. The other organs show no 
particular change to the naked eye. 
Microscopical Changes 
1. Make thin smears of spleen pulp, liver, bone 
marrow, lung, kidney, testis, lymphatic gland, supra¬ 
renal. Stain with Romanowsky. Parasites occur in 
immense numbers in the spleen, liver, and bone marrow. 
To a less extent in the lungs and testis. They are 
present also in the suprarenals and lymphatic glands. 
2. Make thin smears from granulation tissue of 
ulcers of the skin and intestine. Parasites are present 
in both situations ; in the skin they are scanty, in the 
intestine they may be very numerous. 
3. Place small pieces of these tissues on cover 
glasses. Fix in sublimate-alcohol (p. 404). Embed in 
paraffin. Cut sections. Stain with haematein. The 
study of sections is essential for a clear understanding 
of the relation of the parasite to the tissues. Observe 
the following conditions :— 
Liver .—In the lumen of the capillaries of the lobule, often 
applied closely to the capillary wall, occur numerous large cells crowded 
with parasites. These cells are sometimes retracted and globular, but 
more usually they are characteristically extended, and suggest the 
idea that they are actually moving inside the capillaries. These cells 
are of doubtful nature but resemble the macrophages seen in the 
organs in malaria. In some cases these cells contain melanin. The 
parasites in these cells have the characteristic structure. They 
appear to lie in vacuoles, but these are undoubtedly the body of the 
parasites (Fig. 24). 
Spleen .—The parasites occur in similar cells. They are very 
conspicuous in sections. Large mononuclear cells containing parasites 
are more abundant than in the liver. Neither do the red cells contain 
parasites, nor do free forms occur. 
