89 



early, small, and an old, large caseous area is to be found, 

 nor is there any evidence of a young bud or extension. 



On section of an early lesion, one of two to four weeks' 

 duration, it is seen that the tissue is less tough and pinker in 

 colour. On careful examination small, pale-yellowish, caseous 

 areas are seen scattered throughout. These are much smaller, 

 paler, and softer than the areas seen in older lesions, and are 

 enucleated with difficulty. 



The rather denser nature of the tissues in the glans penis 

 apparently prevents the tumours reaching the size they attain 

 in the looser tissues of the sheath, and, likewise, the tissue 

 reaction is greater in the tumours from the latter situation. 



The appearances of the lesion removed from the meta- 

 carpal region of the case mentioned above vary somewhat from 

 those found in lesions from the penis and sheath. Beneath 

 the ulcerated surface there is dense, sclerosing, fibrous tissue 

 extending 5 mm. in depth, which has probably resulted from 

 treatment with antiseptics. Beneath this is looser fibrous 

 tissue containing translucent, greyish areas, somewhat circular 

 in shape, and containing sometimes a yellowish point. 



The lesions observed by Lewis and Seddon were of the 

 nature of a granuloma, involving the inner canthus of the 

 eye and the membrane associated as a rule with irritation of 

 the cornea and lacrymation. Yellowish necrotic areas were 

 seen in the submucous, and sometimes the subcutaneous 

 tissues. They were found on both surfaces of the membrana 

 and in the skin of the lower lid and palpebral portion of the 

 conjunctiva. 



Microscopic examination. — The microscopic picture is 

 typical, but varies with the age of the lesion. In the older 

 lesions, where it may be impossible to demonstrate any casual 

 organism, the tumours nevertheless present quite a character- 

 istic histological picture. 



In a section of a tumour from the glans penis it is seen 

 that the epithelium is usually ulcerated about the summit of 

 the growth. The ulcerated surface consists of ordinary granu- 

 lation tissue, in which are many capillary blood vessels and 

 a marked infiltration of the tissues with eosinophile leucocytes. 

 At times caseous areas are seen on the ulcerated surface. At 

 the edge of the ulceration the stratum comeum is seen to be 

 slightly thickened, while the rete mucosum shows hypertrophic 

 changes, anastomising processes dipping deeply into the cutis 

 vera. The rete mucosum at this point is usually slightly 

 infiltrated with eosinophile leucocytes. The epithelium cover- 

 ing the tumour in th§ other situations sometimes shows slight 

 hypertrophic changes, but it is otherwise normal in appear- 

 ance. The cutis vera is normal in these situations, except for 



