PART II,] Resemblance of the Delhi Sore to Lupus. 431 



elements of the rete press into the cutis. A decidedly epidennoid character is not 

 assumed by the cells : they are young cells, of irregular form and of moderate durability. 

 . . The cells do not lie loose in the areolae, but are surrounded by tough, mucous 

 intercellular substance giving a precipitate with acetic acid. The cells are delicate and 

 fragile, and one may readily infer that they are only nuclei. ... A careful examination, 

 however, will reveal that they are cell bodies, generally rounded, but often oval or 

 even spindle-shaped. They envelope the round or oval, large and generally single 

 nucleus tolerably closely, and the latter is provided with one or two nucleoli. It is 

 only towards the surface that the cells become multi-nucleated, occasionally presenting 

 precisely the appearance of pus corpuscles." * 



Subsequent to the period at which this description was written several distinguished 

 observers have paid special attention to the pathology of Lupus, and notably so during 

 the present and past year. Thoma also directs attention to the gradual extinction of 

 the boundary line between the corium and rete Malpighii — such an extinction as may 

 be observed delineated in our iigure of a section of the Oriental sore (Fig. 22, c) ; and 

 lays stress on the point that the cell formations which take place in the corium are 

 the essentially Lupus elements. At first, he says, cell-growths occur in the perivascular 

 spaces of the blood-vessels of the skin,t aggregations of lymphoid elements which 

 gradually penetrate all the interfascicular spaces of the corium, separating the connective 

 tissue filaments normal to the corium.| 



Still more recently Lange has published a carefully written paper on the " Histology 

 of Lupus," accompanied by figures which might almost have served as illustrations to 

 many of our own preparations of the " Delhi sore." 



We might go on citing authorities concerning this matter almost indefinitely, but 

 as it is not our intention to discuss the various doctrines maintained regarding the 

 particular tissues primarily involved in the affection, or to express any opinion on purely 

 histological points, enough has been written to show that the microscopical changes 

 which characterise the " sores " ordinarily met with at Delhi, and which are considered 

 endemic to this and other localities, differ in no material manner from the changes 

 which have been described as taking place in the various forms of Lupus in Europe. 

 To those who desire a lucid resume of the various doctrines advocated in connection 

 with the pathology of Lupus, we would recommend the perusal of the chapter on the 

 subject in the last edition of Neumann's work on " Skin Diseases." § 



Although none of the various pathological changes which have been described 

 in connection with Lupus, and which we now refer to in relation with the Oriental 

 sore when taken singly, can be designated as peculiar to either the one or the other, 

 seeing that similar changes, though possibly differing in degree, are known to occur 



* Op. cit., pages 487-8. 



t This view is in accordance with the researches of Dr. Thin regarding the origin of Lupus Erythematosus ; 

 Lancet, January 16th, 1875. 



X Virchow's Arcliiv. Band. LXV ; Heft. 3 ; S. 335—1875. 



§ " Lehrbuch der Hautkrankheiten," von Isodor Neumann ; vierte Auflage — Wien 1876. 



