înch fom the bases of his first and second toes. The tumours itch and are 
painful on pressure. 
Clinical Examination. — Showed the patient to be perfectly healthy with 
the exception of the skin lésions. These are of the same type as in Case I. 
When punctured they yield blood only and films of this blood show in 
everv instance L. tropica. These however are not nearly so numerous as in 
Case I. The greatest number was found in the knee growth. They occur 
both free and in the mononuclears and présent no spécial features. A good 
many of them appear to be smaller than those in Case I. The tumours show 
no tendencv to ulcération and quickly heal under a scab after being punc¬ 
tured. Blood from the skin covering the growths shows no parasites. 
The measurements of the growths are as follows : 
On the thigh, i et 2 combined.... 17 mm. x 12 mm. 
On the thigh accessorv. 7 mm. x 7 mm. 
On the knoe . to mm. x 10 mm. 
On the foot . 5 mm. x 5 mm. 
•«* 
Blood examination. — The blood coagulâtes very rapidly. A blood count 
made by Captain Ensor on nov. 2 nd. showed 4.700.000 red blood corpus- 
eles and 16.000 leucocytes. It will be remembered that the patient at this time 
had a boil on his face, probably the cause of the leucocytosis. After a week 
the leucocyte count dropped to 12.000 although the patient was being treated 
bv Captain Ensor 21 with tincture of senega according to his méthode in 
Kala-azar cases. As he was anxious to test the effect of the drug the case 
was handed ever to him and has not been studied so fully by us as was.Case I. 
Jt is chiefly of interest in that, it is an example of the transmissibility of 
the disease and, apparently, of the same type of the disease. What was the 
agent of transmission ? Was it a bed bug ? This is perhaps the most likely 
insect for bugs, C. lectularius are a ccmmon pest in barracks tenanted by 
Egyptian troops. Next most likely is a Phlebotomus said by Pressât 22 to 
be blamed by the fellaheen in Egypt and regarded by Sergent and others as 
tt possible vector. 
This and other questions we would leave to a later paper and 
conclude bv thanking Captain Ensor S.M.O., Khartoum, for 
help in connection with the cases and Dr. Beam for the trouble 
he took to secure good photographs of these interesting skin 
lésions. 
Note. — Since this paper was written a second article 23 by 
Carter has appeared in whieh he draws attention to the varions 
•types of oriental sore which exist in India, mentions a non-ulce- 
rating form, apparentlv not identical with that we hâve descri- 
bed, and like us, takes exception to the term oriental sore, though 
without putting forward any substitute. He also refers to the 
possibility of there being different varieties of Leishmania, an 
observation with which we whollv agréé and in the light of 
which we hope to study the parasites found in the skin lésions 
descri bed. 
