suppurated again, and at the present time ther.? exists a circular scab of a dark-grey colour, of the size of a four-anna piece, of whitish ichorous discharge on squeezeng which a few drops containing air bubbles exuded, and on raising which (which was difficult) the characteristic ulcer was seen. After the lapse of four months from the commencement of the above-mentioned pimple another made its appearance on the opposite patella and ran an exactly similar course, witii the exception that the discharge from this was sanguineous, and that the sore hsaled eventually and left a somewhat large scar.
A CASE OP Under the
care
of
Dr.
ORIENTAL SORE." Lucas, Civil Sufgoon9 ?c.} \Bushiref "
Persia.
[Reported by Apothecary Ahmed Khan. J Ebkahim, a Persian, aged 46, applied at the Dispensary, Bushire. on May 18th,for deafness without any pain or discharge in or from the ears, audit was only accidentally that Dr. Lucas noticed the peculiar cutaneous affection on his hands whilst presenting to him his ticket. History.?Born in Bushire and resided there all his life; is married and has children, but, none is similarly affected. He enjoyed excellent health before the disease commenced at the time of the famine in 1871, but the patient did not share in the distress, his circumstances and means having been better then than they are now. A small pimple first appeared on the inferior border of the right patella ; it got larger, till it attained the size of a fig; there was no pain during its progress, but he is said to have been subject to fever, the nature of which cannot be clearly elucidated. At this stage of the disease the patient, at the advice of a barber, introduced a needle, which was followed by the discharge of some yellow matter. The sore healed partially, but
On the ball of the right great toe there is an open circular ulcer of the size of a rupee, and in depth of about t wice its thickheals at ness ; this is said to have existed a considerable time, certain times, but breaks ouen again. On closer examination the surface of this ulcer is dry, and with a magnifying lens not The edges were sloped a single granulation can be detected. off from within outwards, and with the aid of the lens three minute apertures were seen in its centre penetrating pretty deeply into the tissues. On looking at the sole of the opposite foot a cicatrix of a former ulcer is seen on exactly the corresponding spot as is occupied by the ulcer on the right foot. On the palmar surface of the right thumb there is an ovalshaped ulcer of the size of a pigeon's egg, the centre of which Its general characters exposes to view the red muscular fibres. are the same as those of the one on the foot, and therefore Its duration is said to be needs no further description only ten days. The opposite thumb is not affected. Besides tliesf ulcers, scabs, and scars, there are several others situated on the legs, arms, and hands. The characteristics of the cicatrices are that they do not seem contracted, but. appear rather to be loose ; are neither depressed nor elevated, but have a shiny or glazed .aspect, and in some (though not all) the disappearance or absorption of pigment therefrom renders their appearance not unlike that of leucoderma. It is interesting and worthy of record that in all without, exception, in the vicinity of the ulcers as in the scars, there is nearly complete anajsthesia. These last two symptoms are important, as they tend to make the disease simulate leprosy. With reference to the deafness, for which the patient sought advice, on examination with a speculum Dr. Lucas discovered h small oval-shaped, dry ulcer situated on each membrana tympani. On the buttocks there were numerous little boils of a florid hue. They are not unlike the tubercles of syphilis. The lymphatics of the groins and axilla? are said to have enlarged, and were very tender when the boils in the extremities The face, thighs and trunk are were in a state of inflammation. entirely free from disease present or past. The patient denies having ever had syphilis, and no symptoms of this disease exist. His account as to his habits of life, etc., is far too vague and indefinite for record, but his food has been what these races generally take?a coarse sort of bread, something like Indian chupaties, dates, and fish, which are all tolerably abundant nnd cheap here. His general health otherwise is fairly good. I must not omit to mention here that from these ulcers and scabs there is a very peculiar odour, something like that from dried fish. Treatment.?The scabs covering, and the integument surrounding, the ulcers were carefully excised, and a paste consisting of liquor zinci chloridi (B P) and flour was applied. No pain was felt, nor did the patient complain of any during A mixture containing carbolio the application of the paste. acid was ordered to be taken thrice daily. The paste was renewed for the next two days, after which some burning pain was complained of, with an appearance of sloughs and redness round the sores. It was then stopped and poultices were
applied
:
points of interest in this case are ; I.?The prolonged duration, intractable and obstinate nature of the affection, showing little tendency even to exhaust itself. II.? The symmetry of the affection attacking successively the two corresponding sides. III.?The relation, if not simulation, to leprosy on the one hand, and to syphilis on the other. IV.?It is, fro 'i the history of the case and general symptoms, quite clear that the disease is a constitutional and not merely a local one. Dr. Lucas examined a few specimens microscopically, and observed that a vertical section of a piece of integument, taken from the margin of the ulcer in the foot, shows under a hi
A CASE OP Under the
care
of
Dr.
ORIENTAL SORE." Lucas, Civil Sufgoon9 ?c.} \Bushiref "
Persia.
[Reported by Apothecary Ahmed Khan. J Ebkahim, a Persian, aged 46, applied at the Dispensary, Bushire. on May 18th,for deafness without any pain or discharge in or from the ears, audit was only accidentally that Dr. Lucas noticed the peculiar cutaneous affection on his hands whilst presenting to him his ticket. History.?Born in Bushire and resided there all his life; is married and has children, but, none is similarly affected. He enjoyed excellent health before the disease commenced at the time of the famine in 1871, but the patient did not share in the distress, his circumstances and means having been better then than they are now. A small pimple first appeared on the inferior border of the right patella ; it got larger, till it attained the size of a fig; there was no pain during its progress, but he is said to have been subject to fever, the nature of which cannot be clearly elucidated. At this stage of the disease the patient, at the advice of a barber, introduced a needle, which was followed by the discharge of some yellow matter. The sore healed partially, but
On the ball of the right great toe there is an open circular ulcer of the size of a rupee, and in depth of about t wice its thickheals at ness ; this is said to have existed a considerable time, certain times, but breaks ouen again. On closer examination the surface of this ulcer is dry, and with a magnifying lens not The edges were sloped a single granulation can be detected. off from within outwards, and with the aid of the lens three minute apertures were seen in its centre penetrating pretty deeply into the tissues. On looking at the sole of the opposite foot a cicatrix of a former ulcer is seen on exactly the corresponding spot as is occupied by the ulcer on the right foot. On the palmar surface of the right thumb there is an ovalshaped ulcer of the size of a pigeon's egg, the centre of which Its general characters exposes to view the red muscular fibres. are the same as those of the one on the foot, and therefore Its duration is said to be needs no further description only ten days. The opposite thumb is not affected. Besides tliesf ulcers, scabs, and scars, there are several others situated on the legs, arms, and hands. The characteristics of the cicatrices are that they do not seem contracted, but. appear rather to be loose ; are neither depressed nor elevated, but have a shiny or glazed .aspect, and in some (though not all) the disappearance or absorption of pigment therefrom renders their appearance not unlike that of leucoderma. It is interesting and worthy of record that in all without, exception, in the vicinity of the ulcers as in the scars, there is nearly complete anajsthesia. These last two symptoms are important, as they tend to make the disease simulate leprosy. With reference to the deafness, for which the patient sought advice, on examination with a speculum Dr. Lucas discovered h small oval-shaped, dry ulcer situated on each membrana tympani. On the buttocks there were numerous little boils of a florid hue. They are not unlike the tubercles of syphilis. The lymphatics of the groins and axilla? are said to have enlarged, and were very tender when the boils in the extremities The face, thighs and trunk are were in a state of inflammation. entirely free from disease present or past. The patient denies having ever had syphilis, and no symptoms of this disease exist. His account as to his habits of life, etc., is far too vague and indefinite for record, but his food has been what these races generally take?a coarse sort of bread, something like Indian chupaties, dates, and fish, which are all tolerably abundant nnd cheap here. His general health otherwise is fairly good. I must not omit to mention here that from these ulcers and scabs there is a very peculiar odour, something like that from dried fish. Treatment.?The scabs covering, and the integument surrounding, the ulcers were carefully excised, and a paste consisting of liquor zinci chloridi (B P) and flour was applied. No pain was felt, nor did the patient complain of any during A mixture containing carbolio the application of the paste. acid was ordered to be taken thrice daily. The paste was renewed for the next two days, after which some burning pain was complained of, with an appearance of sloughs and redness round the sores. It was then stopped and poultices were
applied
:
points of interest in this case are ; I.?The prolonged duration, intractable and obstinate nature of the affection, showing little tendency even to exhaust itself. II.? The symmetry of the affection attacking successively the two corresponding sides. III.?The relation, if not simulation, to leprosy on the one hand, and to syphilis on the other. IV.?It is, fro 'i the history of the case and general symptoms, quite clear that the disease is a constitutional and not merely a local one. Dr. Lucas examined a few specimens microscopically, and observed that a vertical section of a piece of integument, taken from the margin of the ulcer in the foot, shows under a hi
