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However, not only from a clinical standpoint do the descriptions in 
the literature differ, but also from a pathological-anatomical one, the 
reports of the histological appearances either showing considerable varia- 
tion in the lesions, or, at least, nothing sufficiently characteristic. to make 
an accurate diagnosis of the condition possible. Obviously, these descrip- 
tions might be expected to vary greatly in the different stages of the 
affection, since after the lesions have progressed from the “boil” stage 
to the ulcerative one and secondary infections have occurred and cicatri- 
zation has resulted, the appearances must differ considerably from those 
seen in their incipiency, and hence the diagnosis of the affection from a 
pathological standpoint is attended with additional difficulties. 
Cunningham, (8) who in 1885 described peculiar parasitic organisms in 
the tissues of specimens taken from this disease, states that, apart from 
the presence of these organisms, the lesion presented no specific char- 
acters, but was essentially a simple granuloma, such as might arise in 
connection with the presence of persistent irritation dependent upon 
various causes. 
Babes, (9) in his consideration of the pathology of Oriental boil, remarks 
that one is unable to distinguish the condition from an etiological stand- 
point, because the pathological changes are not sufficiently different from 
those frequently encountered in various other boils or furuncles. 
Allusion has already been made to the similarity in the pathological 
conditions which Plehn refers to in yaws and Delhi boil, while in the 
articles of Riehl, (10) Leloir, (11) Unna, (12) Kuhn, (13) and Jean- 
selme differences in the histological changes are also mentioned; some 
of which, it is true (but probably not all), depend upon the stage in which 
the lesion was examined. Kuhn, in his, article on the histology of 
“endemische Beulen,” emphasizes the fact that but few characteristic 
changes were found, though it must be mentioned that from a study of 
the literature and photographs he concluded that endemic boil exists as a 
(lisease sua generis. 
It is not my purpose here to enter into any further discussion of the 
literature in regard to this question, since the references given above will, 
I believe, convince the reader that confusion has occurred in the diagnosis 
of this disease, and it is more than likely that several different affections 
have been described under the terms Delhi, Aleppo, Biskra, Gafsa boil, 
oriental bouton or sore, tropical ulcer, Pendjeh, Yemen, Sarten ulcer, ete. 
One might then be prepared to expect that many specific organisms 
should have been reported for this type of ulcer, and indeed such is the 
case. However, many of these observations have to-day only a historical 
interest or value. 
In 1868 Smith (14) believed that he had succeeded in finding, in the sections 
of a tropical ulcer, ova of a species of distoma. Fleming, (15) in 1873, also 
thought that he had encountered the eggs of some parasite in the tissues from 
a case of Delhi boil. However, later he attributed another significance to the 
