1888-89.] Dr R. W. Felkin on Tropical Diseases. 
289 
Egypt between Suez and Cairo. In Asia it is more widely distri- 
buted; it is seen at Broussa, and in Syria it is endemic, chiefly be- 
tween Killis and Aleppo. In Mesopotamia it is endemic over the 
wdiole plain between the Euphrates and the Tigris, extending from 
Diarbekir to Bagdad and Bassara. In Persia it is endemic at 
Teheran, Kashan, and Ispahan; whereas in Hamadan it is not so 
frequently seen. There is also a small endemic focus in the district 
of Elizabethpol. 
The sore is met with in Tashkend and skirts the river Tchirtchik, 
and in all probability it exists in Turkestan, Afghanistan, and 
Beloochistan. Another Very important endemic area extends along 
the Indus from the Punjaub southwards through Scinde as far as 
Goojerat and the Gulf of Cambay, and to the east through Rajpootana 
and the North-West Provinces as far as Delhi, Meerut, Lucknow, 
and Gwalior. 
Remarks . — Objection may be taken by some to classing under 
one heading a sore having so many names, but it seems to me that, 
taking all things into consideration, the various designations all 
refer to one and the same disease, and that their different features 
are simply modifications produced by varieties of climate; their 
various manifestations are also most probably, to some extent at 
least, influenced by racial characteristics and by the habits of the 
patients attacked. In each locality where these sores obtain, they 
vary considerably in their appearance with the character of the 
season. Two theories have been, and still are, advanced as to their 
cause, some authorities considering that they are a local manifesta- 
tion of a cachectic condition due to a residence in unhealthy localities 
or badly drained towns in certain parts of the tropics. Others 
again, and notably Carter, consider that the disease is distinctly 
due to a parasite, and this view is supported by cogent facts. Carter 
has found in the sores spheroids and mycelium ; the disease is 
localised, and this fact is against it being the outward manifestation 
of a constitutional state. The disease can be innoculated, and it is 
contagious. Again, many facts lead one to suppose that the parasite 
is introduced into the body, either during ablution or by the bite 
of some insect. 
The area of the distribution of this disease prevents us enter- 
taining the idea that its production is influenced by the physical 
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