﻿554 SHATTUCK. 



A smear from the scrapings showed many polymorphonuclear leucocytes, a 

 few large and small basophiles and occasionally a plasma cell. A very few 

 cocci were observed, but no other bacteria nor parasites. In addition, a few round 

 bodies identified as blastomyces by their contour and budding were evident in 

 the smear from the exudate. A section stained with hematoxylin and eosin 

 showed all the layers of the skin and a little subcutaneous tissue. Ulceration, 

 infiltration, and necrosis of the upper layers of the skin appeared at one edge of 

 the section. There was an increase of dense, fibrous tissue in the deeper parts 

 of the sections and strands of this tissue ran out to the edge of the ulceration. 

 The tissue near the ulceration was (Edematous. Coagulation-necrosis, deposit 

 of fibrin and considerable infiltration with small round and plasma cells and 

 a few polymorphonuclear leucocytes was present. Other sections were stained 

 for tubercle bacilli, as well as by the methods of Wright, Giemsa, Gram-Weigert, 

 and silver impregnation. A few Gram-staining cocci were seen near the edge 

 of the ulcer, but no blastomyces. 



This lesion corresponds pretty closely to Strong's description of his 

 "ulceration of the first type." On the one hand, the scarcity of pus is 

 common to both, and the mode of onset is much the same ; on the other, 

 Strong encountered an oval blastomyces in the tissues, whereas in this 

 case a round one was found sparingly in the exudate. It must be borne 

 in mind that in this case the condition had existed for four years when it 

 came under treatment, and that probably the lesion had been thoroughly 

 curetted when the stitch was put in before specimens were obtained. 

 Supposing it to be of parasitic origin, the parasites may either have 

 died or have been scraped out. The duration of the ulcer in this in- 

 stance was four times as long as is usual with Oriental sore. The find- 

 ing of blastomyces in the exudate, which might have been secondary 

 invaders, is of no yalue, and yet the assumption of a blastomycotic 

 origin would explain the chronicity and mildness of the lesion better 

 than any other diagnosis I can make. 



SECOXD TYPE OF ULCERATION. 



Case II. — Native, age 21.* Patient says that five months ago he had swel- 

 lings in both groins which disappeared under treatment by a Chinese physician. 

 There was also a sore on his penis. Then a small boil appeared in the right groin, 

 resulting in an ulcer which spread slowly in spite of treatment. Another 

 ulcer developed later between scrotum and thigh. The patient was treated for 

 a month in the out-patient clinic and was admitted to the wards a month ago 

 because the ulcers were obstinate. At the time of entrance he had a large 

 chancroid on the penis. The chancroid has improved, but the large ulcer has 

 remained in spite of vigorous anti-syphilitic treatment. On the contrary, several 

 small ulcers have appeared recently near the anus. 



The patient was fairly well nourished. He had no skin lesions other than 

 those already mentioned. There was slight, general, glandular enlargement. 

 The throat was negative and there was no periostitis. Extending from the base 

 of the scrotum to the inner aspect of the right thigh was a smooth, granulating 

 area neither elevated nor depressed and measuring about 10.5 centimeters in 



4 St. Paul's Xo. 2697. First seen April 24, 1907. 



