Flat Form. The skin here, in contrast to the preceding form, is 
thinned and atrophied, the glands of the skin sharing markedly in 
the atrophic process. The papillae of the Malpighian layer are 
represented by very short processes, or are at the centre of tie 
patch, entirely absent. . 
A sharply defined zone of cellular infiltration, practically 
identical in all respects with that described as pertaining to the 
warty form, is present under the thinned epidermis. Such a 
growth, examined in section with a pocket-lens, closely resembles 
the subcutaneous nodules sometimes seen in cases of leucocythaemia. 
The parasites, which occur in the large mononuclear cells describe 
above, were present in such large numbers in both cases of this kind 
which we have examined, that the sections appeared to be crowded 
with them. , . . f 
The parasites agree in every respect with the descriptions of 
Lehhmama trofica. They are identical in both the warty and fla 
forms of the lesion (PI. XIV, figs, n, I2 > r 3)- f 
Our two examples of the flat form were entirely free from 
micro-organisms. In the warty forms, on the contrary, these were 
constantly present. These micro-organisms were of many d.fferen 
kinds, and as they clearly represented a secondary accidental 
infection, we have taken no pains to determine their nature. T1 y 
were most frequent in the superficial layers, and were never found 
deeply in the centre of the growth. , 
The examination of a large number of specimens has shown 
that in those cases in which bacteria were most plentiful, parasite 
occurred in very scanty numbers or not at all. ur °P lnl 1 . 
so far from there being anything of the nature of a s y“ bl ° 
between the two, the appearance of bacteria mvolva.The extmet o 
of the parasite. The reason why we have failed o find the 
parasites in so many of the cases reported, is proba y 
process of extinction had reached a point where exceed S y ^ 
if any, parasites had survived. The specimen which contamedl the 
parasite in largest numbers was one which contained ™ g 
Whether the bacteria ever destroy the parasites sufficentiy to bring 
about a natural cessation of the process we have 
judging, but it seems quite possible. wh i c h the 
The condition is therefore essentially 
