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Geographical distribution.— Neal, Ozzard, Conyers, and Daniels describe a peculiar form of ulcerating granuloma affecting more particularly the pudenda in dark -skinned races. Their observations were made in British Guiana, and principally on West Indian negroes. Daniels believes that he has seen a similar or the same disease in Fijians. The "serpiginous ulceration of the genitals" referred to by McLeod, and more recently by other writers in India— especially by Maitland— is the same, or a similar disease, examples of which I can recollect having seen in South China. Taylor of New York has seen it in whites in the United States, Goldsmith has met with it in aboriginals in North Australia, and Renner in West African negroes. Doubtless, therefore, although hitherto little notice has been taken of this disease, it is widely distributed in the tropics. Etiology.— There is reason for believing that the disease is generally, though not invariably, a venereal one. Maitland has seen it in the mouths of a husband and wife. He considers it may be inoculated on other forms of venereal sore, such as an ulcerating bubo, and that a compound sore may result.

Spirochætes resembling S. pallida and S. refringens have been described by Wise as occurring in the ulcerations in British Guiana, but the nature of their relation to the disease has not been made out.

Donovan described certain parasitic elements in scrapings from the deeper parts of the Madras form of these sores. The parasite (Fig. 93) is like a short bacillus with rounded ends, measuring 2 μ by 1 μ. It occurs in mononuclear cells and in great profusion. The parasites are sometimes scattered irregularly