99 
only the distorted and deeply staining nuclei of these cells can be seen, 
the protoplasmic portions having disappeared. In addition, small round 
cells and a few leucocytes are present. No fibrin and no bacteria or other 
parasites can be detected. Beneath this area in the corium there is 
infiltration with small round cells. The microscopical picture is some- 
what similar to that which Gilchrist has described in the papillary variety 
of erythema multiforme. In other portions of the tissue in the region 
of the ulcer similar areas of degeneration may be found in the papillary 
layer of the corium. In a section of one of the ulcerations near its edge 
there may be seen on the surface a superficial layer of coagulation 
necrosis, in which fragmented nuclei and polymorphonuclear leucocytes 
are present. A few cocci may be distinguished in these areas. A small 
amount of fibrin can also be demonstrated. In places the necrosis does 
not extend below the corneous or the mucus layer, being entirely confined 
to the epidermis. In other portions of the section the papillary stratum 
is exposed, which then also shows inflammatory infiltration. 
The lesions of this affection bear some resemblance to those described 
by F. Plehn?® in his mild cases of “ulcerative dermatitis,” but the distribu- 
tion of the ulcerations is different. The disease seems to bear no resem- 
blance whatever to the affection known as chappa, as described by Read, 
or,to that of Pian bois, by Darier and Christmas.* Perhaps in the 
ulcerative stage it might be considered as one of veld sore,® in which 
secondary infection has occurred, but until its etiology is discovered, it is 
difficult to classify such an affection. By some observers it might 
perhaps even be considered as belonging to the type known as Oriental 
sore. 
CONSIDERATION OF THE ETIOLOGY OF DELHI SORE OR BOIL. 
During the past few years the study of one form of tropical ulcer has 
assumed renewed interest, chiefly, perhaps, owing to the discovery by 
J. Homer Wright, (1) in 1903, in a case of Delhi boil, of certain bodies 
which have considerable resemblance to the organisms already described 
by Leishman and Donovan in cases of tropical splenomegaly. While, in 
general, the clinical descriptions of this type of tropical ulcer (Delhi boil 
or Oriental sore), as found in several of the text-books on tropical diseases 
agree quite closely, when one examines into the clinical features, as set 
forth in the individual papers of those who have made special studies with 
reference to the etiology of this form of ulcer, considerable differences 
in the descriptions are found. Indeed, in many of these articles the 
reports of the macroscopical appearances of the lesions vary so widely 
that one is almost led to conclude that more than one type of the disease 
has been described under the name of Delhi boil. Such an opinion is not 
“Die Kamerun Kiiste, Berlin (1898). 
* Ann. derm. et d. syph. (1901). 
*Harman, Journal Pathology and Bacteriology (1903). 
