92 
spot on the right side of the chest just below the clavicle and above and 
to the right of the breast. The lump gradually enlarged, but occasioned 
little pain. When I first saw the boil it was about the size of a half 
dollar and had not opened. The skin over the center was scaly, indurated, 
and reddened. Fluctuation could be obtained. On incising the abscess 
in the center, a scanty, rather thick, purulent material was found and a 
small ulcerating cavity, containing soft granulations, was exposed. On 
the following day, under cocaine anesthesia, the whole cavity was carefully 
curetted. The operation was thoroughly performed, because the patient 
insisted on leaving on the next day for the provinces to be gone for several 
months. Directions were given for the daily antiseptic dressing of the 
wound. I was unable to see her again until four months later, when, 
after repeated requests, she finally returned to the city and exhibited to 
me a contracted scar the size of a dollar, situated over the original site 
of the lesion. She reported that the wound had gradually healed, about 
two months after leaving the city. Portions of the granulations which 
were removed with the curette were hardened in Zenker’s fluid, embedded, 
sectioned, and stained in hematoxylin-eosin, hematoxylin-picrofuchsin, 
methylene-blue-eosin, fuchsin, Borrell’s stain, and Wright’s modification 
of Romanowsky’s method. Figs. 1 to 10, inclusive, are photomicrographs 
made from these sections.* 
The histological changes in the portions of the granulation tissue which 
were removed consist of a chronic inflammatory process in the subcuta- 
neous tissue, with areas of acute inflammation, showing cellular infiltration 
and in places necrosis, together with considerable fibrin formation. In 
addition, the infiltration consists of numbers of cells whose protoplasm 
stains poorly, of fragmented nuclei, polymorphonuclear leucocytes, and 
small round cells with deeply staining round nuclei. In places the 
lymph spaces are widened, and there is an extensive proliferation of the 
endothelial cells of the lymphatic vessels, and in some areas these 
occur in rows, thus suggesting their origin from their arrangement. 
There is also considerable proliferation of the fixed connective-tissue cells. 
Multinuclear giant cells are occasionally observed and plasma cells are 
fairly numerous. In certain of the inflammatory areas eosinophiles are 
greatly increased in number and not infrequently many free eosinophilic 
granules may be seen, but only occasionally a mast cell is visible here. 
In the sections a striking feature is the presence of numerous large endo- 
thelioid phagocytic cells, with a relatively large amount of protoplasm 
and with a large round or oval nucleus, which may contain a nucleolus, 
Sometimes the margins of these cells are indistinct. No bacteria are 
evident in the sections. The presence of parasites, which are scattered 
throughout the tissue, is of chief interest. These may be described as oval 
‘T wish to express my thanks to Mr. Willyoung, of the Biological Laboratory, 
for his suecess and interest in the staining of the parasites in the tissues of this 
case, 
