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



in other cutaneous affections, still, taking the appearances in the aggregate, they are 

 sufficiently characteristic, more especially when, in addition, the clinical features of 

 Lupus and of the Oriental sore are considered and compared. There can then be 

 little doubt but that the diseases correspond in all the main points, and may be looked 

 upon as essentially the same. 



Whilst this paper was in course of preparation, we had the opportunity of perusing 

 a very carefully written account by Dr. Greber of a sojourn in Aleppo for the purpose 

 of investigating the nature of the aiffection known as the "Aleppo Bouton.'"* The 

 sores referred to under this designation are, as already intimated, considered by all 

 authorities to be, in all essential points, the same as those encountered in other parts 

 along the Mediterranean, in Egj^pt, Arabia, India, and other Eastern countries. Dr. 

 Greber has come to the conclusion that several kinds of affections are designated by the 

 same term in Aleppo, but that all of them may be readily identified by any experienced 

 dermatologist. For the most part, he looks upon the sores which prevail as more or less 

 typical of Lupus ; but a considerable number of the " boutons " investigated proved to be 

 of syphilitic or scrofulous origin. 



These observations are in complete accord with our own experience in Delhi, with 

 the exception that we did not observe any instance in which cases had been diagnosed as 

 Delhi sores, by a qualified observer, which had any history to indicate that they were due 

 to syphilis or scrofula. Errors of diagnosis, doubtless, occur in the bazaars and among 

 the population generally, but the cases which medical practitioners recognise as Delhi 

 sores are, we believe, for the most part cases of one or other of the varieties of 

 Lupus. 



It is, however, highly probable that, owing to climatic and other differences, the 

 disease may be modified in some degree from its European prototype ; we know that 

 it differs from it in being more localised to certain districts ; in this, however, it is not 

 altogether peculiar, for there are some other diseases which manifest distinctly endemic 

 proclivities in this country without any such proclivities being recognised in England. 

 Dr. Geber cites an instance of a school in Aleppo in which he identified 24 cases of 

 Lupus (in addition to other skin affections) among 130 children, all of which were 

 recognised there as '' boutons." It would be hardly possible to find a school with such 

 a proportion of sores in England, or to meet with such a number of persons in the 

 streets marked with sores or their cicatrices as may be met with in Delhi. It seems, 

 then, but natural to infer, that although the character of the sores present so much 

 in common with Lupus as seen in Europe, some peculiar conditions exist in the locality 

 which are sufficient not only to induce or predispose to the disease, but also possibly, 

 in some respects, to modify its character, so that it would be well for purposes of 

 classification to give it a specific designation. We would propose, therefore, that Ltijjus 

 endemicus might be adopted as a sufficiently explicit definition of its nature and 

 habitat. 



* " Erfahrungen aus meiner Orientreise." Viertrljf/ /irc-srhi'ijt fur Dennatologic. Heft 4. Wien 1875. 



