xiii, b, 4 Wade: Studies on Cryptoplasmic Infection 169 



down after an indefinite period. Usually they were not in them- 

 selves painful, though sensitive to manipulation. 



Shallowness of the ulcer itself and fairly extensive under- 

 mining of the skin along an advancing border (as in fig. 2, 

 etc.) were features of the superficial lesion. Frequently, how- 

 ever, deeper structures had been more or less promptly invaded, 

 with disturbance of function and, in one case (fig. 5), shorten- 

 ing of an affected member. Fusion of separate ulcers or pro- 

 gression of lesions irregularly outward with cicatrization of the 

 older central area had given rise to considerable irregularity 

 of outline of the affected areas. Induration of the advancing 

 margin was usually noticeable, though skin that had become 

 well undermined might on the surface still appear practically 

 normal. The floor of the ulcer was usually covered with a thin 

 layer of pale necrotic material. Beneath this was a shallow, 

 pale granular layer of invaded subcutaneous tissue, more or less 

 soft and friable, sometimes exuberant and vascular, bleeding 

 freely on manipulation. Those lesions invading deeper struc- 

 tures could not be investigated. 



The process had sometimes subsided greatly only to break out 

 afresh, with activation of indolent lesions and development and 

 comparatively rapid extension of new foci. In other cases it had 

 progressed slowly for months and years. It had usually resulted 

 in more or less destruction and cicatrization of the soft parts 

 (fig. 6), though in one case there was considerable thickening 

 of the foot, somewhat suggestive of a mycetoma. 



I am informed that administration of potassium iodide in 

 large doses caused improvement in the cases so treated; how- 

 ever, the period of observation after treatment was begun was 

 too short for results to be apparent. Conditions have prevented 

 subsequent observation. 



MICROSCOPIC FINDINGS 



Smears. — Nothing has been found in stained smears to which 

 the causative role could be possibly assigned. In those from 

 superficial levels bacteria of different types are found, though 

 they are not numerous. Polymorphonuclear leucocytes usually 

 predominate. In smears from the deeper levels bacteria are 

 scarce when found, and cells of the lymphoid type usually pre- 

 dominate. Eosinophiles are sometimes numerous. 



The only objects of interest observed with any regularity are 

 small, round or oval bodies, staining deeply with Loeffler's blue 

 or Giemsa's stain, apparently produced by fragmentation of 

 leucocytes. In some preparations they are scarce, and in others 



