426 The " Oriental Sore " as observed in India. [part ir. 



however, may be ascribed more manifestly to modifications of pre-existing structures 

 — modifications, too, which presumably are the indirect results of the development of 

 the corpuscular elements which have just been referred to. These changes are most 

 pronounced in the case of the hair and the sebaceous follicles (Fig. 22, m. g). The 

 hair itself disappears more or less completely, at most leaving but very trifling traces 

 in the form of a few hardened scales (%), or perhaps merely a small heap of molecular 

 debris. As already mentioned, the altered follicles become pushed forward by the 

 new grow^th until, eventually, in advanced cases they are found lying free on the 

 surface of the sore (Figs. 16, 17). 



The sebaceous follicles also suffer in like manner (Fig. 22, g) ; indeed, it is very 

 seldom that they can be identified as glandular structures at all when the particular 

 sore examined is not a very recent one. There does not appear to be any infiltration 

 of lymphoid corpuscles into either the hair or the sebaceous follicles ; the changes in 

 both consist, for the most part, apparently, in an increase in the size and the more 

 pronounced character of the epithelial cells which enter into their formation, just as 

 was observed to take place in the mucous layer of the epidermis. With reference to 

 the sebaceous follicles, however, we were not able to satisfy ourselves that more 

 changes than this had not taken place, as some of them appeared to be filled with 

 material consisting of broken-down epithelial elements, or with indistinctly marked 

 lymphoid corpuscles. We are, however, inclined to refer it to the former. The 

 fibrous tissue forming the capsular investment of both classes of follicles were 

 frequently infiltrated with accumulations of lymphoid cells. 



The sweat glands, situated in the lower part of the corium (Fig. 21,^, Fig. 22, r), 

 are not appreciably affected unless the sore is in a very advanced state. Frequently 

 the glandular convolutions may be seen to present an almost perfectly normal appear- 

 ance (Fig. 22, -»'), even when surrounded by the lymphoid corpuscles. The ducts, 

 however, are generally larger than usual, and sometimes they are seen to have become 

 obliterated, apparently as the result of the pressure exercised by the newly-formed 

 cells of the sore. Occasionally, however, the appearance presented by the cellular 

 lining of the ducts and its convolutions seemed to indicate that, as in the case of the 

 sebaceous glands, some change had occurred, but whether neoplastic or retrograde we 

 were unable to decide. 



It is in connection with the vascular structures of the corium that the essential 

 features of the disease are most prominently observed. This, however, does not imply 

 that the primary deposit takes place in the interior of the vessels, or even in the 

 interior of the capillaries ; for very frequently sections of the blood-vessels parallel to 

 their course may be encountered, which prove that they contain no corpuscular 

 elements other than those normal to them, although it is frequently to be noted that 

 they are very full. The same is observable in transverse sections. The coats of the 

 vessels are, however, generally thickened and somewhat more readily resolved into 

 their cellular elements than is the case in normal tissues. 



