TWO CASES OF NON-ULCERATING "ORIENTAL SORE " 199 



Manson' says little — " Section of the papule displays an infiltration of the derma by 

 a mass of small round granulation cells. These lie between the elements of the tissues, 

 particularly about blood-vessels, lymphatics and sweat-glands ; towards the centre of the 

 lesion they completely replace the normal structures." 



Wright,'- in his original paper, states that " the lesion consists essentially of a very 

 extensive infiltration of the corium and papillic by cells, accompanied by atrophy and 

 disappearance of the epidermis of tlie part. Tlie infiltrating cells are plasma cells, 

 various kinds of lymphoid cells, and large cells with single vesicular nuclei and a 

 relatively large amount of cytoplasm, in which are large numbers of the micro-oi-ganisms. 

 These large cells, over extensive areas, are very numerous, and constitute the principal 

 part of the infiltration. They are regarded as proliferated endothelial cells." 



Brooke^ mentions the researches of Carter, Eeihl, Leloir, Unna and Kuhii, "who all ".^^ chronic 

 found it to be a chronic sero-fibrinous inflammation. There is a round-celled infiltration ^'■jo-fibrmous 



inflammation 



of the skin and subcutaneous tissue. In the centre of the nodules this infiltration is so 

 dense that the tissue elements are entirely disintegrated. The lymphatic vessels are 

 dilated and there is much oedema. Necrosis proceeds in the centre of the infiltration 

 tissue. There is cornification of the hair root-sheaths, preventing a subsequent new 

 growth of hair at the spot. There is endothelial proliferation of the blood-vessels, often 

 leading to their entire obliteration." 



Christophers and Stephens,' in their latest edition, do not deal with the subject, 

 nor does Daniels.' The English translation of Scheube's'' work has a passage much like 

 that in Brooke's book : — 



" There is an infiltration of the skin and subcutaneous tissue, with small round oval 

 cells, nailti-granulated and giant cells, and also a few leucocytes. In the centre of the 

 nodules, over which the epithelium is attenuated, the infiltration is so dense that the tissue 

 elements are entirely disintegrated, while towards the periphery the cells form small 

 centres, mostly situated in the vicinity of blood-vessels and lymphatics and sweat glands. 

 The lymphatic vessels and spaces are uncommonly wide, and there is csdema. In the 

 centre of the infiltrated tissue, small necrotic particles are enclosed, and this, when 

 the sections are stained, exhibits large fibrinous contents ; the tissue otherwise also contains 

 much fibrin (Unna). Those hairs that still exist are, according to Kuhn, partly broader, 

 partly narrower, occasionally ravelled, and they always exhibit a granular appearance. 

 The root-sheaths are sometimes dilated. Here and there the inner root-sheaths, and 

 to a great extent the outer root-sheaths, are also transformed into, a shiny mass, probably 

 cornified. In the connective tissue around the hair follicles, cavities are found tilled with 

 shiny flaky masses which, according to the way they are cut on section, appear of a round 

 or oval form. In consequence of the cornification of the root-sheaths no new growth of ■Endothelial 

 hair is possible. The blood-vessels exhibit endothelial proliferation, which mav lead proliferation" 



^ in blood-vessels 



to their entire obliteration." 



Firth,' in Allbutt's Si/stem. of Medirine, has a lengthy description as follows : — 

 "The histology of these sores has been thoroughly worked out; and, if sections 



be made of the initial papule before ulceration, no difficulty is experienced in demonstrating 



■ Manson, Sir P. (1907), Tropical Diseases (4th Ed.). 



- Wright, J. H. (December, 1903), "Protozoa in a case of Tropical Ulcer." Jnu.ninl of MerUcal Hesenrch. 



'■' Brooke, G. E. (1908), Tropienl Jfetlieine, Hityiene and Paranitologit. 



* Stephens, J. W. W., and Christophers, S. R. (1908), The Pmetical Study nf Mnhiria, etc., (3rd Ed.). 



''■ Daniels, C. W. (1907), Laboratorij Htudics in Tropical Medicine (2nd Ed.). 



'■ Scheube, B. (1903), The Diseases of IVann Countries. Edited by J. Cantlie. 



' Firth, R. H. (1907), In AUliiitt's Siislcm of .Uetlieine, Vol. II., Part II. 



