months after they were first noticed, they are practically in the 
original condition. 
For the last month, two of the spots which have been used for 
microscopic examination, have taken to remaining open for a few 
days, but always heal up again with the aid of a simple dressing. 
Smears were taken in April, 1910, and typical parasites 
(Leishmania tropica) found. None were found in the peripheral 
blood, though many attempts were made to find them. 
Cultures were tried twice on sodium citrate, acidified with citric 
acid, and incubated at 22 0 C. according to Rogers’ method, but no 
result was obtained. Cultivation was then tried on blood agar, 
with positive result in each tube inoculated. The cultures showed 
Hcrpetomonas forms after two days’ incubation, but it was found 
impossible to maintain them and to make subcultures owing to the 
contaminating micrococci of the skin. 
PATHOLOGICAL HISTOLOGY OF THE LESIONS 
It may at once be said that the pathological features of the two 
types above described present an underlying identit). T e 
differences between them, although very great, both as regards their 
naked eye and histological characters, are, we believe, exphcab e 
on the ground of accidental influences depending on situation, 
exposure to friction, bacterial invasion, etc. I he essential identit) 
of the two forms is indicated not only by the presence in each of 
indistinguishable parasites, but by the essentially similar nature 
of the sub-epithelial infiltration which both picsent. 
Warty Form . So far, we have only observed the warty forms in 
exposed situations where the skin is normally of considerable 
thickness, and where such growths are liable (in the absence of an) 
protective covering) not only to bacterial invasion, but also to 
proliferative changes consequent upon the maintenance of a chronic 
inflammatory condition from irritative influences of a 
nature. . , 
In a thin paraffin section including the elevated margin 0 t e 
lesion, one sees a number of vertical epithelial columns w 
penetrate the dermis sometimes to a depth of 7 to 8 mm. 
Small, apparently isolated down-growths of epithelium, 
