﻿GANGOSA IN THE PHILIPPINES. 393 



of necrosis beyond the advancing edge of the ulcer. This section differs 

 from the others in the relative abundance of granulation tissue. In the 

 other sections there is very little granulation tissue formed. 



In sections stained by the Weigert-Gram method and for tubercle 

 bacilli there is nothing characteristic. No acid-fast bacilli are found. 

 There are a number of cocci, mostly diplococci, and a few slender, blue- 

 staining curved rods on the free surface of the ulcer; elsewhere no 

 bacteria. 



The heart. — Stains well; the structure is well preserved; the epicar- 

 dium slightly cedematous ; in the meshes are scattered a few small, round 

 cells and occasionally, cells with red protoplasm; the muscle fibers also 

 are quite widely separated, the intervening spaces being clear or con- 

 taining small amounts of pale, pink, granular or fibrillated material but 

 no leucocytes. The vessels are normal and show no perivascular leu- 

 cocytosis. 



The protoplasm takes a bright eosin tint ; striation and fibrillation are 

 distinct; the muscle nucleus is surrounded by an oval, clear space two to 

 five times the length of the nucleus, containing only a slight amount of 

 brownish pigment. This central clear space often makes the fibers which 

 are cut on longitudinal section appear to be split, and in general the 

 muscle fibers are drawn out into longer and narrower ribbons than usual. 

 The nuclei are small, fairly uniform, pale and vesicular with a darker 

 nuclear capsule and a variable number of chromatin dots. A moderate 

 number of fibers show myocardial fragmentation with the stair-like ar- 

 rangement of fibrils. 



Lung, hcematoxylin and eosin and, tubercle stain. — Typical, acute 

 broncho-pneumonia is shown in one section. Some alveoli are nearly 

 clear; others contain coagulated albumin. Congestion, oedema and de- 

 squamation also occur; in other places there are consolidated areas in 

 which the alveoli are packed with polymorphonuclear leucocytes, red 

 blood cells and fibrin in varying amounts, fibrin being unusually abun- 

 dant. A bronchiole cut in the section has its wall infiltrated with poly- 

 morphonuclears and its lumen stuffed with them, together with a few 

 desquamated cylindrical cells. 



In another block the lung tissue has broken down forming a small 

 abscess. 



Section through another nodule presents a different appearance. Here 

 the process answers to the description of disseminated tuberculosis of the 

 lung. There are discrete and confluent miliary nodules, surrounded by 

 consolidation beyond which is more or less normal lung tissue. 



In the center of a miliary nodule is a nearly concentric whorl of 

 coarse, red, coagulated fibrillar material. Surrounding this center is a 

 zone of more loosely lamellate'd fibrinous material, in the meshes of which 

 are a moderate number of epithelioid and small, round cells. There is 



