200 



TWO CASES OF NON-ULCERATING "ORIENTAL SORE " 



" A reaction of 

 the skin 

 ag:iinst some 

 virus of low 

 virulence " 



No parasites 

 in blood from 

 cut surface 



that the whole thickness of the skin and subjacent tissue is infiltrated with lymphoid 

 and epithelioid (niesohlastic) cells, accompanied l>y more or less complete disintegration of 

 the normal tissue-elements thereby. In the centre of the papule tiie inliltration by young 

 round cells is so complete that little can be seen of the sweat-glands. Towards the edges 

 of the diseased area, the new cells occur in isolated clusters or groups, chiefly round blood- 

 vessels or lymphatics. The infiltration does not seem primarily to involve either the 

 hair-follicles or the sebaceous glands. The individual cells of this infiltration vary from 

 7/1 to 9/( ; tiieir nuclei from 5^ to 6;i ; the nuclei are large, generally single, but in parts 

 multiple. The aiuitomical structure of the papule and surrounding skin indicates that 

 oriental sore is of the type of a granuloma ; in fact the most elementary microscopical 

 examination of the lesions shows that it is a reaction of the skin against some virus of low 

 virulence, which has produced granulomatous changes in the corium beneath and round the 

 ulcer. So chronic are the changes -which are sometimes met with, that a close resemblance 

 to tuberculosis may be occasioned. It is important to bear this in mind, because it 

 has several times been suggested that certain of these lesions are tuberculous. Doubtless, 

 syphilitic and tuberculous ulcers have, from time to time, been placed in this group, but that 

 there is an entity to which the term oriental sore is applicable, which is due to some virus 

 dififerent from syphilis and independent of tubercle bacilli, seems certain." 



Jackson,' on the other hand, states that the pathological anatomy of tropical ulcer 

 needs to be cleared up by further study. None of these accounts, it will be seen, mentions 

 the presence of cell nests, or even the increase in the rete Malpighi, which was so marked a 

 feature in the sections of the small growth first studied. We were inclined to ask if this 

 tumour was taking on malignant features, if it was a true oriental sore in the papular 

 stage, or if these descriptions referred only to the ulcerative stage of the lesion. Hanson's 

 brief statement, however, distinctly mentions section of the papule. 



Another and larger growth of four months' duration, that on the outer surface of the 

 left forearm, was excised and examined. After excision, blood was taken from the cut 

 surface, but no parasites were found in it, nor were they present in blood-stained serum, 

 obtained by thrusting a capillary pipette through this surface and some distance into the 

 tumour mass. This is a point of some interest. 



Thin sections were made of the growth and stained by Leishman's method, with 

 rieidenhain's iron hsematoxylin, with hsematin, Van Gieson's stain, eosin and methylene 

 blue, hsematoxylin and thionin blue, ami, following Nattan-Larrier and Bussiere,'- with 

 carbol-thionin. 



The appearances presented by these sections were much more likr the description 

 quoted. There was not nearly so great a proliferation of the rt'tc Malpif,'lii. tiiough here 

 also, in some parts, a tendency to down-growth and to the formation of cell nests was 

 noted. A study of the sections stained with eosin and methylene blue, however, 

 showed that the cells present in the sub-epidermic layer answered very closely to those 

 mentioned by Wright. Indeed all the classical signs were to be observed, and there could 

 be little doubt that the condition was identical with that found by many observers. In 

 these sections there W'ere not, as a whole, nearlj- so many parasites as in those of the 

 small growth first examined, and they seemed to be confined to the endothelial cells and 

 the mononuclears. In certain areas, however, sections stained with carbol-thionin and 

 carefully differentiated with spirit, showed a heavy infection of the cells. 



' Jackson, T. W. (1907), Tropical Medicijie. 



' Nnttan-Larrier, L. ,ind Bussiire, A. (January 13, 1909), " Repartition des T^icishmaiiin dnn.s le bont^u 

 irOri.'nt." null. \;„-. l;uh. Kxid. Paris. 



