xin, b, 4 Wade: Studies on Cryptoplasmic Infection 171 



cultures, an inadequate explanation. There are sometimes found 

 areas containing numerous minute to coccoid or larger granules 

 and prominent shreds that stain intensely with basic dyes, 

 as if of nuclear material (figs. 13, 14, and 15) . Their source is 

 not evident, unless they result from chromolysis of leucocytes, 

 yet they are found in areas too recently invaded for necrosis 

 of the leucocytes ordinarily to be expected. 



In most sections nuclear changes in the leucocytes are notice- 

 able. Among typically stained lymphocytes there may be more 

 or less numerous round, solid, intensely staining bodies of the 

 same size, apparently pycnotic individuals. In the acute exudate, 

 both in the recently invaded areas and in regions of extensive 

 infiltration and histolysis (figs. 18 and 19), polymorphonuclear 

 leucocytes undergo, instead of ordinary necrosis, globular frag- 

 mentation (figs. 20 to 28, inclusive) , by which the nuclei separate 

 into 3 to 6 or 8 discrete, round, dense bodies, which lie in well- 

 outlined pale red protoplasm. The size generally varies in- 

 versely with the number; occasionally there are as many as 12 

 to 15 fragments that are mere granules. This is evidently the 

 same process as seen in the smears. The masses apparently do 

 not long survive as such after the protoplasm breaks down, 

 for free bodies are nowhere numerous. 



In some cells there are but two bodies (figs. 20 and 27), and 

 in others but a single, round, comparatively large nuclear mass. 

 In its size and in the appearance of its protoplasm this mono- 

 nuclear cell is similar to the multinucleated cells ; it appears to 

 be a polymorphonuclear the nucleus of which has fused into a 

 solid, round mass. 



CLINICAL DIFFERENTIATION 



In certain clinical features, but especially in the impossibility 

 of establishing a definite clinical diagnosis, this ulcer is like 

 certain of those reported by previous authors. Leprosy, tuber- 

 culosis, discomycosis ("streptothricosis"), and "blastomycosis" 

 of any type may be ruled out on the absence of the specific 

 organism, as is dermal leishmaniosis, or oriental sore, which 

 is not known to exist in these Islands. The lesion is clinically 

 unlike the syphilitic ulcer, and the patients denied having had 

 primary or secondary lesions. 



The two lesions that have particularly to be differentiated 

 are the tropical ulcer and late yaws. The former is rather the 

 more similar and is not positively differentiable on clinical 

 grounds, though those cases of tropical ulcer that I have seen 

 usually did not exhibit the undermining so prominent in the 



