63 o - 
The patient complains that the growths itch intensely when exposed to 
the sun’s rays and that they pain him, when pressed or iwhen they corne 
violently into contact with anything hard. 
The people of his village pronounced him <c Waash )) i. e. unclean and 
refused to eat with him. 
Clinical examination. — General appearance healthy, expression dull and 
apathetic, no wasting, no sign of any systemic diseased, no glandular enlar- 
gement. Heart, lungs, liver and spleen normal. 
Urine — no sugar, no albumin. 
The growths, in the situations indicated, resemble nothing so much as the 
mountains on a relief map (fig. 3) looked on from above. There is the 
main élévation with spurs and ridges projecting from it, these latter repre- 
senting the secondary growths which hâve united with the parent lésions. 
The tumeurs are of a definite pink colour, contrasting well with the 
brown pigmented skin, hâve a shiny aspect, are neither scalv nor ulcerated 
and show no signs of breaking down. To the touch they feel smooth, firm 
yet soft consistency, are easily movable and are not adhèrent to the deeper 
tissues. 
When punctured, they either yield blood alone, or blood with sérum, « r 
blood and a small quantity of white cheesy sebaceouslike material. After 
puncture the site of injury heals readily and a small scale or scab forms. 
This is well seen in Fig. 2. On section, to the naked eye, the growths appear 
fibrous. The following are the measurements of the growths. 
On the face. 20 mm. x 18 mm. 
On the neck. 35 mm. x 15 mm. (Fig. 3) 
Over insertion of left deltoid. 5 mm. x 5 mm. 
On outer surface left forearm. —not measured — excised. 
On right shoulder... 20 mm. x 14 mm. 
On right upper arm.. 29 mm. x 18 mm. 
On left thigh. 2\ mm. x 2^ mm. 
On back. 2^ mm. x 2^ mm. 
Blood examination. — An examination of blood taken from the finger 
made on october ioth showed 6,050.000 red blood corpuscles and 5,600 
leucocytes. Leucopenia therefore is présent. The haemoglobin was not deter- 
mined — the blood was of a good colour. Its coagulability was markedly 
increased. A differential leucocyte count waë made with the following re¬ 
suit : 
Eosinophiles. n,6 °f 0 
Polymorphs . 57,4 % 
Mononuclears . 4,2 °/ Q 
Large lymphocytes . 8,6 % 
Small lymphocytes. 16,2 °/ 0 
Transitionals. 2,0 °/ Q 
With the exception, therefore, of a marked eosinophilia — the resuit pro- 
bably of infection with metazoan parasites, so common in these fellaheen — 
the count was normal. No protozoal parasites of any kind were found. 
Very different was the differential count in blood taken at the same time 
from the growth on the neck. It gave : 
Eosinophiles. 2,2 °/ Q 
Polymorphs. 26,8 % 
Mononuclears . 23,6 % 
