430 The *' Oriental Sore'' as observed in India. [part il 



CHAPTEK VI. 



REGARDmG THE PROBABLE NATURE OF THE ORIENTAL SORE AND ITS RELATION TO RECOGNISED 



SKIN AFFECTIONS IN EUROPE. 



We trust that our descriptions of the clinical and pathological features of this sore suffice 

 to decide as to the propriety of identifying it with a form of a cutaneous afifection which 

 exists in Europe, and of classing it among the recognised skin diseases. For our own part 

 we have little doubt that were a person suffering from such an affection to present 

 himself at any of our English or Continental hospitals without divulging an Oriental 

 history, there would be no great hesitation on the part of the physician in diagnosing 

 the case before him. Given, for example, a case in which a sore is found on the cheek, 

 another on the forehead or back of the hand, with perhaps a scar or two elsewhere, 

 the cicatrices of former sores. Assume that one or more of these are surrounded by 

 a somewhat hardened, slightly elevated, glossy margin ; that they are nearly painless, 

 have been very gradually, almost imperceptibly, spreading for weeks or months, although 

 the general health of the patient does not appear to have been materially affected, and 

 that no history of syphilis or scrofula can be ascertained. Putting these leading points 

 together, the physician would in all probability pronounce it a case of one or other of 

 the generally recognised forms of Lwpus. 



When, in addition to the clinical history and microscopical appearance of the 

 affection, the microscopical features of the sore, as given in the last chapter, are 

 carefully considered, the evidence in favour of the correctness of such a diagnosis is almost 

 beyond question. The pathological changes which we found to have occurred in the 

 corium and in the rete mucosum correspond very accurately with what Virchow has 

 described as characteristic of Lupus in his classical work on " Diseased Tumours." * 

 Had Professor Virchow's description been published as one referring to specimens of the 

 Oriental sore as seen at Delhi, we would unhesitatingly have added our testimony 

 to its surprising correctness. His description of epidermal changes, of the changes in 

 the hair and sebaceous follicles in Lupus find their counterpart in our own description 

 of this sore, and we are particularly struck with the similarity which exists between 

 his description of the epidermoid character of some of the portions of diseased tissue 

 in Lupus and what we have seen in the Oriental sore, and that, too, at a considerable 

 distance from the epithelial layers. 



Professor Virchow writes : "The Lupus growth consists of young, tough, and generally, 

 vascular, granulating tissue, which as a rule contains small round cells, which may so 

 closely resemble the cells of the rete Malpighii, that it is difficult to differentiate 

 the boundaries between the rete and the Lupus tissue. Frequently it seems as 

 though the boundary had been obliterated, but I cannot admit, what might readily be 

 supposed, that the cutis itself becomes transformed into a rete Malpighii, or that the 



* " Die Krankhaften Geechwulste," — Band II. S. 485, et seq. 



