MORBID ANATOMY 345 



will probably be some firm nodules beneath the skin and, per- 

 haps, one or more nodules that have softened, forming fluctu- 

 ating abscesses. The regional lymphatic ducts are corded and 

 the glands inside the thigh are hardened and nodulated. 



' ' The earliest observed symptom may be the occurrence of 

 a firm nodule, from the size of a pea to that of a walnut, 

 beneath the skin, anywhere on the body. Corded lymphatics 

 extend from this lesion. In time, the nodule will soften and, 

 at length, its purulent contents will break through the skin. 

 The time required for these developments is most variable and 

 may reach several weeks. Such pus is thick yellowish or 

 greyish yellow and often it is mixed with blood. Sometimes 

 it contains flakes. 



" In other cases, the first symptom observed is an indolent 

 sore, covered with pus and scab, surrounded by a slightly 

 swollen zone and from which one or more firm cords extend 

 beneath the skin toward the lymphatic glands. This condition 

 is, no doubt, the first to develop, but such a sore often escapes 

 special notice until nodules occur. ' 



' ' Fresh ulcers may be surrounded by a slightly raised 

 zone of bright red granulation tissues ('proud flesh'). The 

 ulcers occur irregularly and they disappear slowly ; some heal 

 in a fortnight, others continue to discharge for months, and, 

 after healing, may break out again. From this long continued 

 irritation and from the formation of scar tissue, the skin thick- 

 ens and the affected parts become indurated. 



" Ulceration sometimes occurs upon the conjunctiva and 

 on the mucous membrane of the nostrils and upper respiratory 

 act ." 



§ 258. Morbid Anatomy. This disease consists in an 

 inflammation of the lymphatics. On section the walls of the 

 vessels are thickened, their internal membrane is congested, 

 and the ducts filled with thick-clotted lymph mixed with pus, 

 which is followed by the formation of the abscesses (pustules) 

 and granulating sores. The affected parts become indurated 

 as the result of the formation of fibrous tissue due to the 



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