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entirely new. Geber, (2) as early as 1874, doubted that such a disease 
sui generis existed, and he further maintained that there was much abuse 
of the term “Aleppo boil,” because lupus, scrofulous, and syphilitic lesions 
were frequently described under this name. The statement of James, (3) 
one of the most recent contributors on this subject, is also suggestive of 
the idea above given. He expresses the opinion that the appearance of 
some true Oriental or Delhi “sores” is by no means as characteristic as 
one would expect it to be from the descriptions given in books. Inded, 
James found that several surgeons whose experience with the disease was 
extensive, were unwilling to express a definite opinion as to whether a 
given sore was really Oriental sore or whether it was an example of the 
ordinary chronic ulcer so common among the natives of India. He em- 
phasizes the fact that Oriental sore does not always present very definite 
characteristics and states that in two of his cases the diagnosis was at first 
mistaken, the sore in one instance being considered primarily as a form 
of ringworm and in the other as an ordinary “shoebite.” The gross 
appearance of the lesions in a number of the cases which James studied 
etiologically also varied widely. 
- Plehn, (4) in his very recent article on this subject, calls attention to the 
fact that it has not been thoroughly established that the symptom-complex 
described by the various authors and observers in different regions unger 
the name of “Beulenkrankheit” represents a single distinct affection. 
According to him, some of the descriptions of the lesions might apply to 
those of furunculosis or of tertiary syphilis or of lupus, and he feels 
convinced that such errors in diagnosis in the ulcerative stage of the 
lesion, have certainly occurred frequently. Plehn further comments upon 
the fact that only in Jeanselme’s recent article is framboesia considered 
in the discussion of the differential diagnosis, and although he emphasizes 
the fact that he does not consider the two affections identical, neverthe- 
less, he believes that in their external appearances as well as in their 
histological structure they in some respects show so great a similarity 
that any one who is familiar with only one of the affections could occa- 
sionally mistake it for the other. 
Jeanselme (5) in his article states that, while the bouton d’Orient may 
have a typical aspect and evolution, numerous clinical varieties may also 
exist. These he describes, and in the discussion of the differential 
diagnosis of the affection, the lesions of syphilis, of lupus, of leprosy, and 
of yaws are considered. He also refers to the presence of a lymplrangitis 
in association with the lesion which extends from the region of the ulcers 
and causes a swelling of the adjacent lymphatic glands. The normal 
condition of the glands in Oriental sore has usually been emphasized by 
other observers as an important symptom in the differentiation of this 
affection from “ yaws.” Kaposi’s (6) and Duhring’s (7) clinical descrip- 
tions of the malady vary so widely that some investigators have doubted 
whether these authors observed the same affection. 
