PART II.] Description of tJie Pale or Ochroid Variety of the Disease. 345 



endemic areas of the disease, and feel that the careful study of the specimens which 

 have been at our disposal has rendered us much better prepared for the clinical study 

 of the disease and the investigation of the conditions under which it is developed than 

 we could otherwise have been. 



We owe the materials which we have examined to the kindness of Dr. Cornish, the 

 Sanitary Commissioner for Madras ; Dr. Gamack, Civil Surgeon of Madura ; Dr. Mark 

 Robinson, at present acting for Dr. Gramack ; Dr. Kenneth McLeod ; Dr. Downie, lllwar ; 

 and to the Civil Surgeon of Cuddapah ; all of whom have, from time to time, either 

 themselves supplied us with valuable specimens or have induced others to do so. We 

 wish also specially to acknowledge the obligation which we are under to Dr. McConnell, 

 the Professor of Pathology in the Calcutta Medical College. He has not only aided us 

 by supplying us with numerous specimens of the disease, but has placed the valuable 

 collections in the Pathological Museum under his care at our disposal for purposes of 

 examination and comparison. 



The amount and variety of the work involved in working out the subject has been 

 considerable. Not only has it been necessary carefully to study the condition of the 

 tissues and the nature of the morbid materials present in the various forms under which 

 the disease presents itself, but a close examination of other morbid tissues and products 

 in other diseases affecting similar anatomical regions has had to be undertaken, together 

 with a study of the nature and properties of various natural and artificial oleaginous 

 compounds and concretions ; and numerous and varied attempts at cultivation of the 

 morbid materials, with study of the resultant organisms ; and of the effects of reagents 

 on them and other vegetable growths. 



We take up the consideration of the Pale or Ochroid variety of the disease first as, 

 in many ways, less obscure and complicated in character than that in which the black 

 colouring of the morbid material forms such a striking and characteristic feature. It 

 will perhaps be best in the first place to give a brief description of the appearances 

 presented by some of the specimens which we have examined, and subsequently proceed 

 to consider the common features occurring in them all and, apparently, essentially 

 connected with the disease. We shall then be in a position to state our views in regard 

 to the pathology of the affection together with the grounds on which these are based. 



Specimen I. — This consisted of a foot and ankle. The foot was much thickened, 

 especially towards the ankle, and was straightened on the latter so as to point in a 

 manner resembling that in cases of Talvpes equinus. The toes presented much less 

 distortion and tendency to be turned upwards on the foot than is, in our experience, 

 usually the case in specimens of the disease. The general appearance of the specimen 

 is shown in the woodcut on the following page (Fig. 5). 



Numerous openings surrounded by raised margins, or opening on the summits of ele- 

 vated tuberculations, were present on both upper and under-surfaces of the foot. They 

 communicated with channels lined with smooth membranous tissue and leading into 

 the substance of the foot. On making a section, the knife passed readily through the 



