Symptoms. 737 



suiting cicatrice is transformed into a firm painless node which 

 ma}' attain the size of a pigeon's egg, breaking- spontaneously 

 and discharging a thick, yellowish, gruel-like pus. 



The local process is followed by swelling of the regional 

 lymph vessels which form prominent, wavy and branching 

 painful strands in the course of which develop firm tumors up 

 to the size of a fist, subsequently these become elastic and 

 finally fluctuating and contain the above described thick, yellow 

 pus. The nodes also break and discharge their contents, where- 

 upon they are transformed into fistulous ulcers with indolent, 

 easily bleeding granulating borders. The ulcers frequently 

 produce excessive granulations which lead to the formation of 

 ugly ulcerous surfaces. 



The regional lymph glands swelland form firm, tuberous 

 or nodular tumors which do not adhere to the surrounding 

 tissue; they also suppurate, whereupon the abscesses break 

 spontaneously and gradually heal with scar formation. In 

 some cases an excessive but uniform swelling of the ends of 

 the extremities or the region of the joints may develop followed 

 by ulceration of the overljdng skin. 



In other instances there may be in various regions of the 

 body spontaneous development of flat elevations as large as 

 a copper cent or of nodes approaching the size of a walnut, 

 which break and, after discharging their muco-purulent con- 

 tents, are transformed into flat ulcers which heal without scar 

 formation. In rarer instances numberless minute furuncula 

 appear Avhich partly communicate with each other by means of 

 strands with serous contents which later dry and form scabs. 



In exceptional cases yellowish flat elevations or white 

 nodules as large as lentils occur on the nasal mucous mem- 

 brane. Some of the nodules may have become transformed 

 into ulcers with projecting labiate granulating borders 

 (Pricolo). The intervening mucous tissue is hardly swollen 

 to an observable degree, though it is usually cyanotic; simul- 

 taneously with the appearance of these lesions the submaxillary 

 glands become enlarged and occasionally suppurate. On the 

 other hand nasal discharge is rarely observed. In a case de- 

 scribed by Marcone the nasal mucous membrane was covered 

 with numberless nodules and ulcers, while the turbinated bones 

 were covered with pedunculated growths which had resulted in 

 the partial destruction of the dental alveoli. The nasal alae 

 were much enlarged, firm and studded with small pus foci 

 covered with scabs, in addition to which a thick strand was 

 observed to cross from the left nasal ala toward the facial 

 crest. Cominotti observed a similar case except that the sub- 

 maxillary gland was enlarged to the size of a small apple, 

 only slightly sensitive, bosselated on its surface and not ad- 

 herent to the surrounding tissue. Finally the conjunctiva and 

 especially the niembrana nictitans have in rarer cases been 

 observed to be affected with nodule formation and ulcers 



