﻿392 MUSGRAVE AND MARSHALL. 



layer of epithelium remain fairly characteristic, in spite of the irregular 

 protoplasmic downgrowth. It is to be noted that the nuclei of the epithe- 

 lial cells do not invade the underlying tissue, the downgrowth being 

 altogether protoplasmic. 



Sections B, C, D, E, F, and G, taken from different parts of the ul- 

 cerating area between the anterior nares and the pharynx, have much 

 the same appearance, and are characterized by advancing necrosis with 

 very little reaction on the part of the tissue. The necrosis is advancing 

 upon areolar tissue, upon mucous glands, voluntary muscle, etc. In only 

 one case is there any decided reaction, and that is found in a section taken 

 evidently at the junction of the ulcer and face. The section passes 

 through the edge of ulcer and adjacent skin. At a distance from the 

 ulcer the epithelium is delicate and thin, pigment is abundant, the deep- 

 est layer of cells is uniform, the under surface of the epithelium is fairly 

 even, with only a few small papilla?. The hair follicles, sweat glands, 

 sebaceous glands and subcutaneous tissue appear normal. As the edge 

 of the ulcer is approached, the subcutaneous tissue becomes slightly (ede- 

 matous and finally infiltrated with cells. The epithelium becomes thicker 

 and thicker, the horny layer reduced, the epithelial pegs longer, thicker 

 and more irregular, and the pigment disappears. Just at the edge of 

 ulcer the epithelium dips down as an irregular peg, 1 millimeter into the 

 subcutaneous tissue. The epithelial cells are large, cloudy and pink, 

 often vacuolated, the nuclei are vesicular, pale, uniform and do not show 

 the irregularities met with in epithelioma. 



Over the ulcer there is a thin layer of necrotic, granular, pinkish 

 material, beneath which lies a narrow zone of disintegrating cells, red 

 blood corpuscles, etc., immediately followed by a richly cellular and vas- 

 cular granulation tissue. In this tissue there are many capillaries, round 

 and elongated fibroblasts, disintegrating red blood corpuscles and much 

 yellow blood pigment, and a. fairly large amount of flbrillated intercellular 

 material. In the outer border of the granulation tissue there are a small 

 number of lymphocytes and cells with small, round, dark nuclei and fairly 

 abundant pink to purple protoplasm, the nucleus being sometimes central, 

 sometimes eccentric. Extravasated red corpuscles and yellow blood- 

 pigment are found as far as the deepest limits of infiltration. There is 

 no evidence of perivascular infiltration. There are no polymorphonu- 

 clear leucocytes, excepting at the necrotic edge of ulcer. 



The granulation tissue is less than 2 millimeters at its thickest part. 

 There is an abrupt transition from this to the slightly (edematous, fatty 

 subcutaneous tissue. Within 2 to 3 millimeters of the surface of the 

 ulcer two large arteries are found with their walls very cedematous, and 

 the lumina becoming obliterated. At some distance below the end of 

 infiltration there is found a strand of young granulation tissue and 

 plasma cells, 'but there is no evidence of the occurrence of young foci 



