Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 1.djvu/306

278 Tribondeau states that they are not more than four; I have, however, frequently counted as many as eight and ten in the same patch. The eruption may spread to any part of the body except, in my experience, the scalp. Though several authors state that the eruption never affects the face and axilla, and rarely the palms and soles, I have often observed it in such situations. It is also stated that the nails are not affected, though Manson, who first completely described the disease, said that the nails being affected was of frequent occurrence. My experience tallies with that of Manson. The nails when affected are much thickened, have a rough surface and deep cracks; scrapings examined in Liq. potass. show the fungus. The fungus does not invade the hair follicles.

The general health is not affected, but the patients complain of the disfigurement and of the pruritis. In the hot season the pruritis is much more marked. The disease is very chronic and very difficult to cure.

As regards the development of the disease, I can confirm Manson's description, having made several inoculations. The period of incubation varies between seven and ten days. After this time a slightly elevated brown patch is seen at the place of inoculation; the epidermis in the centre of the patch gives way and a ring of scaling epidermis is formed; this ring expands eccentrically and in the centre again a dark patch appears, which later breaks and another ring is formed inside the first, and so on.

The Blood.—The blood shows a certain degree of eosinophilia, the eosinophiles varying between 6 and 16 per cent. In some cases this eosinophilia was probably partly due to the presence of intestinal worms; the eosinophilia, however, was observed in some cases in which the microscopical examination of the faeces did not show any ova of worms. In very old cases the eosinophilia is more marked than in recent ones; in old cases signs of anaemia may be present.