RHINOSCLEROM. 1. 421 



Whatever may be the cause of measles, it depresses the 

 tissues in such a way as to enable other pathogenic organisms 

 to gain an entrance into the body. Such complications as 

 otitis media, broncho -pneumonia, and noma, which not 

 infrequently follow measles, are probably, in the great 

 majority of cases, to be thus explained. From the first 

 two conditions the usual organisms of suppuration and 

 the pneumococcus have been isolated. Noma in similar 

 circumstances probably arises from a variety of organisms 

 the nature of which is as yet little understood. 



RHINOSCLEROMA. 



This disease, which properly belongs to the group of 

 infective granulomata, is characterised by the occurrence of 

 chronic nodular thickenings in the skin or mucous membrane 

 of the nose, or in the mucous membrane of the pharynx, 

 larynx, or upper part of the trachea. It is scarcely ever 

 met with in this country, but is of not very uncommon 

 occurrence on the Continent, especially in Austria. In the 

 granulation tissue of the nodules there are to be found 

 numerous round and rather large cells, which have peculiar 

 characters and are often known as the cells of Mikulicz. 

 Their protoplasm contains a collection of somewhat gelatin- 

 ous material which may fill the cell and push the nucleus 

 to the side. Within these cells there is present a character- 

 istic bacillus, occurring in little clumps or masses which 

 lie chiefly in the gelatinous material. A few bacilli also lie 

 free in the lymphatic spaces around. This organism was 

 first observed by Frisch, and is now known as the bacillus 

 of rhinoscleroma. The bacilli have the form of short oval 

 rods, which, when lying separately, can be seen to possess 

 a distinct capsule, and which in all their microscopical 

 characters correspond closely with Friedlander's pneumo- 

 bacillus. They are usually present in the lesions in 

 a state of purity. It was at first stated that they could 

 be stained by Gram's method, but more recent observa- 





