86 Vctej'hiary Obstetrics 



extensive experience with the malady in India, fails to record 

 the occurrence of vesicles and pustules. 



In the United States of America, there have occurred approxi- 

 mately 300 cases of the disease, and so far as we can determine, 

 no vesicles or pustules have been observed in any instance. 

 Hutyra and Marek describe eruptions but, on page 464 of their 

 Spezielle Pathologic und Therapie, they pre.sent the illustration, 

 (Fig. 9), of a mare with depigmentation about the vulva, which 

 they attribute to prior ulceration, but they do not illustrate any 

 of these ulcers and the appearances in the picture are identical 

 with the depigmented spots observed in America, which occurred 

 without the prior existence of vesicles, pustules, ulcers or other 

 visible destructive proce.s.ses in the epithelial surface of the skin. 



In the Jahresbericht for 1902, de Does is quoted as having 

 observed the depigmentation of the skin of the external genitals 

 without precedent vesicles or pustules and regarded this loss of 

 pigment as a marked symptom of the affection. 



It seems to us that the apparent differences in observation and 

 view in reference to vesicles, pustules and loss of pigment is due 

 to the constant confusion of the two wholly distinct venereal 

 diseases and to accepting the erroneous conclusion that depig- 

 mentation indicates prior pustular or vesicular eruptions. 



It should be further remarked in reference to the alleged oc- 

 currence of eruptions that the character of the micro-organisms 

 said to cause the disease is contradictory to the appearance of 

 such lesions. Trypanosoma, in general, have little or no tend- 

 ency to produce eruptions or suppuration, and it would .seem 

 unique to expect that, in this one disea.se, alone, of th-'s great 

 group, there should occur characteristic vesicles or pustules. 



The elliptical .swellings or " talerfiecke " in the skin of the 

 flanks, hips and other parts of the body have long held a high 

 place in diagnostic value, but they do not always exist. 



In the Illinois outbreak, the enlarged and pigmentless clitoris 

 con.stituted a noteworthy and highly diagnostic symptom in the 

 mare, persisting for at least two years after all other ph\sical 

 .signs of the malady had di.sappeared. 



The paresis of Dourine is fairly characteri.stic ; accompanied 

 by other lesions and symptoms it is pathognomic, while the 

 peculiar jerky movements in the hind limbs during progression. 



