93 
bodies, which resemble cockleshells, with a sharp outline, measuring about 
3 to 4 win their greatest diameter. In sections stained with hematoxy- 
lin and eosin they usually remain unstained ; in those treated with picro- 
fuchsin, Borrell’s blue, or Wright’s method, they are still to a large 
extent uncolored, but many contain particles of chromatin, which stain 
and which consist, first, of a rounded mass, which sometimes has the form 
of a ring, and secondly, of a small dot or rod. These bodies are found in 
large numbers, both free and inclosed in endothelioid phagocytic cells, or 
lying in a sort of matrix composed probably of degenerating tissue. As 
many as ten or twelve may be seen in a single cell. They are very definite 
organisms and there is no doubt that they are parasites. In not all of the 
cockleshells are the chromatin masses present and many of them contain 
either the ring body or the pigment dot or rod alone (figs. 5 and 9). In 
fact, it is somewhat exceptional to see both chromatin particles in the 
same parasite; or, at least, either the one or the other body alone is in 
focus at one time. The shape of the chromatin masses also sometimes 
varies. Frequently, seal-ring-like forms are encountered (see figs. 7 and 
10), or again at times a crescentic mass of pigment is seen situated alone 
at the edge of the ring. Such examples may be observed in figs. 3 and 4. 
With Zeiss objective DD and ocular 3 the organisms appear as small dots 
and oval bodies, often lying free, but generally inclosed in phagocytic 
cells. Their appearance under this magnification is illustrated in fig. 2. 
The further discussion of these organisms will be taken up below. Agar 
cultures which were made at the time of the curetting of the lesion 
remained sterile. 
I do not wish to be misunderstood as insisting that the lesion in this case 
should be regarded as identical with Delhi boil, but merely to call attention to the 
fact that both in its clinical and in its histological appearance it has many points 
of resemblance to the latter affection. Unfortunately I did not obtain any skin 
immediately over the surface of the boil from this patient. A small portion 
which was secured from the edge of the lesion does not show any destruction of 
the papillary layer, though this shows cellular infiltration near the edge of the 
section. However, this process is more marked in the reticular and subcutaneous 
strata. As will be referred to presently, the diagnosis of Delhi boil is frequently 
extremely difficult since the affection presents so little that is distinctive and 
characteristic. 
ULCERATION OF THE SECOND TYPE. 
The second type of ulcer, when first seen, clinically differed very much 
from the one just described. The patient was a native man 25 years 
of age. The ulcer occurred in the region of the right shoulder, as may 
be seen from fig. 14. No history of injury to the skin or of trauma 
was obtained. ‘The patient stated that a little over two months before 
I saw him, a small, red ‘‘spot” appeared over the right shoulder. This 
gradually enlarged, became hard to the touch, slightly painful, and 
finally a little fluid began to escape from the surface of the sore. Later 
the lesion became covered with a black scab. After this condition had 
