﻿396 MUSGRAYE AND MARSHALL. 



In another section the structure of lymph gland is better preserved. 

 The cell nests and cell strands are clearly marked, in contrast to the 

 dilated sinuses which contain many large, pale cells like those described 

 above. There is no endothelioid cell proliferation at the center of the 

 cell nests. 



In a section stained with Ehrlich's triacid stain and examined with 

 the oil immersion, the large cells in the sinuses take a diffuse, reddish- 

 purple tint, and show no granulation. 



Tissue taken from various parts of the ulcerating area in the nares 

 and prepared by the silver impregnation method of Levaditi do not show 

 spirocliEeta?, nor other characteristic organisms. 



Histological diagnosis. — Necrosis of the nasal passages and adjacent 

 parts; tuberculous nodules in lymph gland, lung, spleen and pan- 

 creas, hyaline and amyloid (?) degeneration of spleen; acute broncho- 

 pneumonia. 



REMARKS. 



The only other histological study of this disease which has come to 

 our notice is that of Fordyce. He removed bits of tissue from the edge 

 and center of the ulcer of his case, and made careful studies of specimens 

 stained with various dyes. Although his case resembles ours in many 

 respects, there are several points of difference. In both cases there was 

 an ulcer bordered by tissue showing an infiltration chiefly with small 

 round cells, but also showing numerous plasma cells. In his case there 

 were but few polymorphonuclear cells ; in ours such cells were difficult to 

 find. Giant cells, which were fairly numerous in his sections, were 

 absent from ours, although in one section there were proliferating capil- 

 laries, which sometimes took the form of a long, vacuolated cell with 

 two or three nuclei. There were no true giant cells in our other sections 

 from the ulcer. In neither case was there caseoiis degeneration, but in 

 ours, even below where the cellular infiltration was marked, there was 

 diffuse, advancing degenerative change in fibrous, glandular and muscular 

 tissue, which was not present in Fordyce's case. In each, there was 

 haunorrage into the tissue, which was quite a striking feature of our case, 

 while new forming capillaries, abundant in his case, were noticeably 

 absent from our sections, except under the ulcer at the junction with 

 the skin of the face. Parakeratosis and acanthosis were noted by Fordyce. 

 The epithelial changes in our case, and described above, were similar, but 

 there was not an increase in the horny layer, which was in fact diminished. 

 The epithelial downgrowth in Fordyce's case gave a picture resembling 

 epithelioma (Plate I), a condition which we could definitely exclude. 



Summary. — The main differences between these two cases are that 

 in ours there was less reaction, no giant cells, more haemorrhage, much 

 less granulation tissue formation, and an extension of the necrotising 

 process beyond the line of infiltration into the structures beyond. In 



