41 8 The " Oriental Sore" as observed in India. [part ii. 



CHAPTER IV. 



CLINICAL FEATURES OF THE ORIENTAL SORE AS SEEN AT DELHI. 



Although the appearance presented by the " Oriental sore " in its advanced condition 

 varies considerably (owing principally, it would seem, to the modes of treatment, 

 accidental as well as intentional, to which such a condition is naturally liable), still 

 there is a certain degree of uniformity in the appearance which it presents at the 

 onset. It generally commences as a pinkish papule, not unlike a mosquito-bite. It 

 may retain this aspect for several days or weeks, or merely attain a more distinctly 

 nodular character. We have heard a patient describe this condition by comparing it 

 to a little seed that had been introduced under the skin. In other cases the 

 tuberculated character is less evident, but in all, so far as we have been able to 

 ascertain, the skin becomes thin and somewhat glistening, and the vascularity of the 

 parts beneath more evident. 



It may gradually disappear without any further inconvenience, but generally it 

 takes one of the two following courses : (1) Either the central part of the papule 

 desquamates, and layer after layer of shrivelled epithelial scales are thrown off, 

 unaccompanied for a long time with any perceptible secretion or distinctly marked 

 scab ; or (2) the desquamation is accompanied with a thickish secretion which forms 

 a hard adherent scab, beneath which a red, raw surface is formed, which may or 

 may not bleed readily on irritation, but is seldom painful. 



The surface thus affected varies in extent from a few lines to one or even two 

 inches in diameter; but the average area occupied by it is about the size of a shilling 

 or half-a-crown. It is not localised to any particular region of the body, several 

 parts of which may be affected at the same time. The forehead, the cheek, the 

 wrist, the back of the hands and feet, the points of the elbows and the knees, and 

 not unfrequently, the side of the nose between the bridge and the inner canthus, 

 are the sites where sores are most commonly found. 



A sore may start from either one or several centres, which, gradually 

 approaching each other, eventually coalesce and become covered by a single scab. 

 Sometimes a shiny, slightly elevated, wheal-like belt of indurated tissue may be 

 observed to encircle the sore, covered with a thin cuticle, and presenting an 

 appearance not unlike that of the indurated tissue forming the margins of a 

 lachrymal sinus, or other fistulous orifice. 



When a poultice is applied, the softened parts become puffy; the adherent scab, 

 when present, becomes loosened, and the sore bulges forward, often considerably 

 beyond the level of the surrounding parts so as more or less to resemble a boil or, 

 even a carbuncle. This condition is represented in the accompanying sketch — the 

 chromolithograph of which, however, is somewhat too hard and diagrammatic (Plate XXVIII, 

 Fig. 1). The normal colour of the scab is yellowish. Owing, however, to the various 



