2

morphological identity with the forms seen in cases of enlarged spleen in
Madras. Wright describes the bodies as largely occurring in the cytoplasm of
cells, especially of the large cells with vesicular nuclei. His photographs shew
that the great majority of the bodies are situated in the cytoplasm of these cells
which appear identical with those I have already described in the spleen, liver,
and bone-marrow and which I have termed macrophages.

      Wright's discovery would appear to modify considerably existing views as to
the nature of the parasite, since the presence of the bodies in immense numbers
in the cytoplasm of infiltrating cells in a focal skin lesion seems opposed to their
supposed rôle as parasites of the red cell or even as solely parasites of the
blood. Laveran and Mesnil,³ however, still maintain the relation of the parasite
to piroplasma. Examining slides sent to them by Donovan, they describe very
small and rare forms in the peripheral circulation which may be free or may be
situated in an unaltered red cell. The small size, the evident great rarity and
especially the absence of the characteristic double chromatin masses make the
relation of these forms to the parasite very doubtful. I have examined both peri-
pheral and splenic blood for appearances which would seem to point to the origin
of the bodies in the red cells, but without result.

      In my first paper I drew attention to certain very definite clinical features of
this disease which is, as a rule, readily diagnosed. I also described three autopsies
and gave the result of an examination of some of the organs and tissues. In the
present report I shall consider the results arrived at under the following heads.

           (1) A description of four further autopsies.

           (2) The salient and pathological nature of the disease.

           (3) The relation of the parasite to the tissues of the host, especially
demonstrating a type of infection in which the vascular endothe-
lium is principally implicated.

           (4) Certain points in the morphology of the parasite and in the nature of
the " matrix" or " zooglea mass."

           (5) A comparison of the conditions found post-mortem in infection with
the new parasite with those found in trypanosomiasis.

Autopsies in fatal cases of the disease.

      AUTOPSY 4.—Child aged about 12. Emaciation marked. Death from
cancrum oris.

        Spleen much enlarged, of firm consistence and dark red in colour, but not
pigmented.

      Liver considerably enlarged; very pale and mottled in appearance. On sec-
tion the mottling was seen to be due to the presence of new tissue of pale hue
replacing the centre of the lobule and extending about half way to the periphery.