﻿48 MUSGRAVB. 



pyogenic ones, probably followed at times by the second kind which is 

 characterized by the development of a cyst wall. However, this is not 

 the universal course of these lesions, for sometimes, particularly in the 

 prostate gland and in the lymphatic glands, the ordinary type of abscess 

 formation is more nearly maintained during the course of the infection 

 and the cyst wall, with the bluish coloration, does not develop. Again, 

 we find the more cystic type of development shown in some of the 

 smallest and earliest lesions. While the ordinary lesions which appear 

 like abscesses often contain ova, their presence can hardly be said to be 

 characteristic of the disease, and this type of lesion is probably due, in 

 part at least, to other etiologic influences. The bluish-slate colored, 

 cystic, abscess-like lesions are more or less frequent in every case. They 

 are characteristic of the disease and have already been described. 



d. Ulcerative lesions are found both in the skin and mucous mem- 

 branes. In both cases they are the result of perforation of lesions from 

 the lymphatics and other underlying structures and are probably never 

 the result of direct infection of the skin or mucosa. They are somewhat 

 distinctive, of a slow chronic type without much acute inflammatory 

 reaction. Their edges are often of a bluish color, and are overhanging. 

 Their contents is of a granular nature and the opening leads to the 

 underlying tissues. The skin ulcers most often are found in regions rich 

 in superficial lymphatics such as the groin or axilla, and the ulcers 

 generally communicate with infected and broken down glands. In one 

 of my cases, two ulcers in the groin had been diagnosed and treated as 

 "tropical ulcer." Microscopic examination of the contents of the lesions 

 at autopsy showed the eggs of the fluke under discussion. 



The tilcers of the mucous membrane are most often seen in the 

 bronchi and in the intestine, less frequently in the bile ducts. When 

 they are in the bronchial tubes they usually communicate with bron- 

 chiectatic abscesses and the primary lesion is in the deeper structures, 

 as has already been described. 



In the intestine, also, the primary lesion is in the deeper layers, and 

 the breaking down of the mucous membrane with ulcer formation is a 

 secondary result. I have not often been able to find eggs in the mucosa, 

 but the deeper structures concerned in the ulcer may have many eggs 

 and sometimes adult parasites. This is in marked contrast to the Schis- 

 tosoma infection, where, for example, the mucous membrane suffers most 

 actively and the eggs are numerous in this part of the bowel. 



The intestinal ulcers are usually of irregular shape and do not bear 

 a definite relation to the mesenteric border or other anatomical struc- 

 tures of the bowel. In -well-advanced cases they may quite closely re- 

 semble tuberculous or amoebic ulceration, particularly when bismuth 

 salts have been administered in the latter cases and the edges of the 

 ulcers have been darkened by impregnation with these chemicals; this 



