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intestinal  symptoms  are  very  commonly  a  feature  of  the  disease  in 
the  earlier  part  of  its  course.  The  intestine,  in  about  a  quarter  of 
the  cases  examined,  has  presented  various  lesions.  .Some  of  these 
had  all  the  characters  of  dysenteric  ulceration  either  in  an  active  or 
chronic  form.  Others  showed  an  enterocolitis,  affecting;  principally 
the  lower  part  of  the  ileum  and  the  entire  colon,  the  inflamed  surface 
being  covered  with  a  thin,  irregular  membranous  exudation.  In  a  few 
cases,  multiple  small  oval  ulcers  of  the  colon  were  present.  Tlieir 
longer  axes,  generally  less  than  one  cm.  in  length,  were  transverse  to 
the  long  axis  of  the  bowel,  and  their  edges  were  slightly  raised,  soft 
and  crateriform.  Microscopical  examination  of  such  lesions  has,  so 
far,  yielded  negati\'e  results,  as  regards  the  presence  in  them  of  any 
unitstial  parasites.  , 
CRITICAL  SUMMARY 
Whatever  the  ultimate  explanation  of  the  condition  dealt  with  in 
this  paper  may  be,  we  feel  that  it  constitutes  a  clinical  and  patho¬ 
logical  entity  the  result  of  some  infective  agent  of  which  we  are  as 
yet  ignorant.  The  possibility  that  either  Bilharziosis  or  Ankylo¬ 
stomiasis  can  have  any  causal  relationship  with  this  disease  cannot,  in 
the  light  of  our  statistical,  clinical  and  pathological  evidence,  be 
admitted.  Bearing  in  mind  the  condition  of  the  blood  and  bone- 
marrow  which  characterises  the  disease,  the  deduction  seems  reason¬ 
able  that,  if  it  be  produced  by  an  infective  agent,  this  is  more  likely 
to  be  found  of  protozoan  than  bacterial  nature.  In  this  connection, 
the  recent  discovery  by  one  of  us  (A.  R.  F.)  of  large  numbers  of  a 
]iarasite  having  the  closest  resemblance  to  that  of  Rala-Azai,  and 
probablv'  identical  with  that  found  in  the  Delhi  Soie  and  Aleppo  Boil, 
pccurriiig  in  ulcerated  papillomatous  lesions  on  the  limbs  of  Egyptian 
fellaheen,  is  not  without  significance.  Dr.  Bitter,  Bacteriologist  to 
the  Government  Department  of  Public  Ilealth,  Cairo,  has  also  found 
similar  bodies  in  a  lesion  of  this  nature.  It  must  be  boine  in  mind, 
further,  that  our  numerous  attempts  to  find  parasites  in  the  internal 
organs  have  generally  been  carried  out  on  patients  alieady  fai 
advanced  in  the  disease.  Kala-Azar,  while  closely  resembling  the 
condition  which  we  have  described  m  certain  respects,  diffeis  from  it 
in  others.  Thus,  the  febrile  onset,  chronic  course,  presence  of 
AA 
