280 . RHINOSCLEROMA. 



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 lying 

 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- 

 tions show that like Friedlander's organism they lose the 

 stain. 



From the affected tissues this bacillus can be easily 

 cultivated by the ordinary methods. In the characters of 

 its growth in the various culture media it presents a close 

 similarity to that of the pneumobacillus, as it also does in 

 its fermentative action in milk and sugar-containing fluids. 

 The nail-like appearance of the growth on gelatine is said 

 to be less distinct, and the growth on potatoes is more 

 transparent and may show small bubbles of gas ; otherwise 

 it resembles the pneumobacillus. It is doubtful whether 

 any distinct line of difference can be drawn between the 

 two organisms so far as their microscopical and cultural 

 characters are concerned. 



The evidence that the organisms described are the cause 

 of this disease consists in their constant presence and their 

 special relation to the affected tissues, as already described. 



