xiii, b, 4 Wade: Studies on Cryptoplasmic Infection 181 



Subsequently the mass was incised by the Commission surgeon, who found 

 only well-vascularized tissue, apparently inflammatory. The condition not 

 being relieved, he then infiltrated the mass with 95 per cent alcohol, 5 cubic 

 centimeters, twice, two days apart. This caused acute pain, which slowly 

 subsided, ceasing entirely after a few days, when the mass began to 

 diminish. When the patient was next seen by me (November 17), there 

 was no trace of the mass itself, but a distinct irregular, shallow area 

 of depression, about 1 by 2 centimeters, could be felt in the bone. This 

 evidently resulted from erosion by the tumor, and probably explains the 

 severe pain. 



Comment. — The etiology of this lesion is, of course, unknown. 

 The efficacy of the treatment applied bespeaks an inflammatory 

 process. The findings in the aspirated material (few polymor- 

 phonuclears and no organisms) and a negative culture are 

 against a bacterial cause. The history, in ulcer cases, of sim- 

 ilar nodules preceding ulceration, the apparent lymphocytic and 

 eosinophilic infiltration, and the curious tendency to affect the 

 bone, corresponding to deep invasion in some of the ulcer cases, 

 makes this lesion of interest as possibly of the same nature. 



SUMMARY AND DISCUSSION 



In the cases detailed above, search along usual lines for a 

 demonstrable causal organism of recognized type, whether bac- 

 terial, protozoal, or fungous, has been totally without result. 

 The lesions, which present clinical evidence of etiological sim- 

 ilarity, are clearly not bacterial, leishmanial, or of the ordinary 

 tropical phagedenic type. There is no positive evidence that it 

 is of syphilitic or frambcesial origin, nor is a treponema dem- 

 onstrable in scrapings. Clinically, therefore, it seems to fall 

 into the category of ulcerative and destructive processes of un- 

 known etiology. 



Intensive cultural study of excised tissues has resulted in 

 observations that are suggestive of a hitherto unrecognized pro- 

 cess of infection. On ordinary media bacterial overgrowth was 

 always prompt and the tissue elements rapidly degenerated; no 

 special feature was seen. On special media, however (nutrient 

 banana and, particularly, nutrient prune agars), leucocytes of 

 the planted tissue fragments instead of disintegrating under- 

 went, in spite of the combined influence of autolysis and bac- 

 terial overgrowth, a change unlike that ordinarily to be seen in 

 such material. This was a peculiar solidification (suggesting 

 hyalinization) that the nuclei underwent, whereby they or parts 

 of them became more deeply staining. This is no doubt in part 

 due to the peculiar effect of these media, on which tissue autolysis 

 is often considerably inhibited. However, apparently by further 



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